WALTER  REED  AND  YELLOW  FEVER 


From  a  photograph  taken  in  1901.        yEtat  50 


WALTER  REED 

AND   YELLOW   FEVER 

By 
HOWARD    A.    KELLY 

PROFESSOR     OF     GYNECOLOGICAL     SURGERY 
JOHNS     HOPKINS     UNIVERSITY 


New  and  Revised  Edition 


Copyright.  1906,  by 
HOWARD    A.    KELLY 


To 
3fam?B  (Harroll 

ana 
to  the  memory  of 

•HUltam  SJa^ear 

this  work  of  love  is  affectionately 
inscribed 


PREFACE   TO    SECOND    EDITION 

A  SECOND  edition  within  six  months!  I  am 
indeed  glad  that  Walter  Reed  and  his  great  work 
have  found  such  a  welcome  at  the  hands  of 
his  countrymen.  It  also  gives  me  great  pleasure 
to  know  that  since  this  little  book  has  told  the 
simple  story  of  his  life,  the  Memorial  Fund  has 
grown  almost  to  completion.  The  second  edition 
will  be  found  to  differ  from  the  first  in  the  correc- 
tion of  certain  errata  which  have  been  pointed 
out  to  me,  and,  more  particularly,  in  the  addition 
of  some  letters  relating  especially  to  the  value  of 
Dr.  Carroll's  work  at  Camp  Lazear  and  at  Las 
Animas  Hospital.  Dr.  Carroll,  Dr.  Reed's  faith- 
ful associate  in  all  his  labors,  is  still  with  us;  in 
what  way  will  the  American  Republic  show  her 
appreciation  of  his  devoted  service? 

H.  A.  K. 

October  26,   1906 


vii 


PREFACE 

MY  pleasant  self-imposed  task  is  at  an  end. 

I  had  hoped  at  the  beginning  that  I  might  be 
able  to  catch  enough  of  that  evanescent  aura  which 
we  call  a  personality,  to  convey  in  written  words 
some  clear  notion  of  the  man  to  whom  it  was  given 
to  make  the  greatest  American  medical  discovery. 
Alas,  as  I  look  upon  my  unfinished  picture,  I  real- 
ise the  impossibility  of  protraying  that  "  animula 
blandula,  vagula,  hospes  comesque  corporis" — 
with  us  so  short  a  time  and  then  gone.  The  mo- 
mentous external  activities  in  which  the  man  was 
engaged  are  easily  recited,  but  the  real  inner  man 
must,  I  think  perhaps  in  all  such  attempts,  evade 
the  crude  methods  of  the  biographer.  Only  He 
who  gave  it  can  really  appreciate  the  spirit  of  a 
man,  as  only  to  Him  who  gave  it  does  that  spirit 
hold  itself  responsible  for  its  activities  during  its 
earthly  stewardship.  The  inspiration  of  Reed's  life 
lies  to  me  in  the  fact  that,  though  a  man  of  war,  he 
ravaged  no  distant  lands,  he  destroyed  no  tens  of 
thousands  to  make  his  reputation,  but  by  quiet 
methods,  when  there  was  no  strife,  he  saved  count- 

ix 


x  PREFACE 

less  lives  and  swept  away  a  hideous  plague,  which 
from  time  immemorial  had  periodically  visited 
our  shores,  devastated  our  fair  land,  and  too  often 
snatched  from  the  years  of  peace  and  plenty  all 
their  blessings. 

My  personal  interest,  as  I  reviewed  the  his- 
tory of  the  various  yellow  fever  epidemics  in  this 
country,  was  enhanced  by  the  fact  that  my  two 
paternal  great-grandmothers  were  sufferers  in  the 
Philadelphia  epidemic  of  1793,  in  which  one  of 
them  died.  The  terrible  cries  of  the  men  who 
drove  the  dead-carts,  "  Bring  out  your  dead!  bring 
out  your  dead!"  lingered  long  in  the  ears  of  my 
great-grandmother,  Mrs.  Thomas  Kelly. 

Acknowledgments  for  hearty  cooperation  are 
due  to  Mrs.  Walter  Reed,  for  her  constant  sym- 
pathy and  ready  aid  given  at  every  phase  of  the 
work.  I  am  indebted  to  Dr.  Reed's  sister,  the  late 
Mrs.  J.  H.  Blincoe,  as  well  as  to  his  brother,  Mr. 
Christopher  Reed,  for  information  relating  to  his 
childhood  and  youth. 

Dr.  James  Carroll,  Dr.  Reed's  friend  and  fel- 
low commissioner,  has  furnished  me  much  valu- 
able information  relative  to  the  work  of  the  Yellow 
Fever  Commission;  while  Major  J.  R.  Kean  has 
given  cheerful  aid  in  securing  data  concerning  his 
army  life. 

I  have  to  thank  my  friend,  Dr.  Mary  Augusta 


PREFACE  xi 

Scott,  Professor  of  English  in  Smith  College,  for 
aid  in  reading  and  criticising  the  manuscript. 

Dr.  Henry  M.  Hurd,  Superintendent  of  the 
Johns  Hopkins  Hospital,  has  proved  a  valuable 
friend  and  helper  on  this,  as  on  similar  occasions, 
in  giving  advice  touching  additions  and  altera- 
tions. 

Professor  William  H.  Welch  wrote  the  pages 
dealing  with  Dr.  Reed's  work  at  the  Johns  Hop- 
kins Medical  School. 

Professor  George  M.  Kober  furnished  the 
photograph  of  the  bust  of  Dr.  Reed  by  Hans 
Schuler. 

There  are  other  acknowledgments  it  would  be 
pleasant  to  make,  if  space  permitted. 

Dr.  Caroline  Latimer  has  been  my  constant 
associate  throughout,  throwing  herself  into  the 
work  with  an  inspiring  interest  and  zeal,  without 
which  it  would  never  have  been  completed. 

HOWARD  A.  KELLY 

May,  1906 


CONTENTS 

PAGE 

CHAPTER  I:   BIRTH  AND   CHILDHOOD. — 1851- 

1876  .  3 

Date  of  birth,  3 — Members  of  family,  4 — Childhood 
and  early  education,  5 — College  life,  6— Graduation 
at  University  of  Virginia,  7 — Graduation  at  Bellevue 
Hospital  Medical  School,  8 — Practice  of  medicine  in 
New  York  and  Brooklyn,  9 — Resolution  to  enter  the 
United  States  Army,  12 — Over- work  in  studying 
for  examinations,  16- — Engagement  to  Miss  Law- 
rence, 19 — Commission  in  Army,  19 — Ordered  to 
Arizona,  21 — Interview  with  Surgeon-General,  22 
— Marriage,  23 — Departure  for  Arizona,  23. 

CHAPTER  II:  FRONTIER  LIFE. — 1876-1889      .     24 

Journey  with  wife  to  Fort  Lowell,  Arizona,  24 — 
Life  in  Arizona,  30 — Journey  to  Fort  Apache,  32 — 
Difficulties  of  housekeeping  on  the  frontier,  42 — Life 
as  Post-Surgeon,  49 — Popularity  with  friendly  In- 
dians, 51 — Struggle  to  maintain  his  authority,  52 — 
Deer  and  turkey  hunt,  53 — Promotion  to  rank  of  cap- 
tain, 56 — Ordered  to  Fort  McHenry,  57 — Work  in 
physiology  at  the  Johns  Hopkins  University,  57 — 
Ordered  to  Nebraska,  58 — Ordered  to  Alabama,  59 
— Efforts  to  undertake  scientific  work  in  the  East,  60 
— Appointment  to  duty  in  Baltimore,  60. 

CHAPTER    III:      BEGINNING    OF    SCIENTIFIC 

WORK. — 1890-1899      ...         .     62 
Work  in  pathology  and  bacteriology  at  the  Johns 
xiii 


xiv  CONTENTS 

PAGE 

Hopkins  Hospital,  described  by  Dr.  William  H. 
Welch,  62 — Appointment  to  duty  in  Washington,  67 
— Promotion  to  rank  of  major,  67 — Foundations  for 
scientific  work  laid  by  life  on  the  frontier,  67 — In- 
terest in  discovery  of  Klebs-Loeffler  bacillus  and  diph- 
theria antitoxin,  70 — Efforts  to  obtain  position  in 
charge  of  sick  soldiers  in  Spanish-American  War,  72 
— Opinion  of  injury  done  to  Army  Medical  Corps 
by  appointment  of  incompetent  persons  to  responsible 
positions,  73 — Made  chairman  of  the  Typhoid  Fever 
Commission,  74 — Extracts  from  published  report  of 
the  Commission,  76-79. 

CHAPTER  IV:  HISTORY  OF  YELLOW  FEVER  IN 

THE  PAST         .         .         .         .         .80 

Clinical  description  of  yellow  fever,  80 — Synonyms, 
82 — Earliest  authentic  accounts,  83 — Discussion  of 
contagion  and  non-contagion  theories  during  the  epi- 
demic of  1793  in  Philadelphia,  84 — Contention  for 
priority  of  publication  of  views  of  non-contagion,  85 
— Attitude  of  Dr.  Benjamin  Rush,  88 — Contagion- 
ists  divided  into  three  parties,  89 — Epidemic  of  1819 
in  Baltimore,  90 — Publication  of  La  Roche's  work 
on  yellow  fever  in  1855,  91 — Early  theories  as  to 
cause  and  transmission  of  the  disease,  92 — Trans- 
mission by  means  of  fomites  first  discussed,  93. 

CHAPTER  V:   INSECTS  AND  DISEASES       .       .     96 

Suggestions  in  literature  as  to  transmission  of  disease 
by  means  of  insects,  96 — Experiments  by  Sir  Pat- 
rick Manson  upon  the  Filiaria  Sanguinis  Hominis, 
98 — Paper  by  Dr.  A.  F.  A.  King  on  "  Insects  and 
[Disease,"  100 — Manson's  views  on  the  transmission 
of  malaria  by  means  of  the  mosquito,  104 — Experi- 
ments by  Major  Donald  Ross,  proving  that  malaria 
is  conveyed  by  the  mosquito,  of  the  genus  Anopheles, 
106 — Confirmation  of  Ross's  experiments  by  other 


CONTENTS  xv 

PAGE 

workers,  ill — First  suggestion  that  yellow  fever  is 
conveyed  by  the  mosquito  made  by  Dr.  J.  C.  Nott, 
112 — Formulation  of  theory  that  yellow  fever  is 
conveyed  by  the  Culex  Fasciatus  made  by  Dr.  Carlos 
J.  Finlay,  113 — Search  for  specific  germ  of  yellow, 
fever  by  different  scientists,  117. 

CHAPTER  VI:   WORK  IN  YELLOW  FEVER       .   120 

Controversy  with  Sanarelli,  120 — Appointment  of 
United  States  Army  Yellow  Fever  Commission,  123 
— Investigation  of  epidemic  at  Pinar  del  Rio,  by 
Reed,  124 — Reed's  reasons-  for  accepting  the  mosquito 
theory  as  a  working  hypothesis,  127 — Description  of 
different  species  of  Anopheles,  129 — Description  of 
Culex  Fasciatus,  130 — Successful  inoculation  of 
Dr.  James  Carroll  with  an  infected  mosquito,  132 
— Death  of  Dr.  Lazear  from  accidental  inocula- 
tion, 134 — Establishment  of  Camp  Lazear,  135— 
Volunteers  for  experimental  inoculation,  139 — Suc- 
cessful inoculation  of  private  John  R.  Kissinger,  140 
— Other  successful  inoculations  and  their  results, 
143 — Experiments  showing  that  infection  from  yel- 
low fever  is  not  conveyed  by  fomites,  145 — Experi- 
ments showing  that  infection  of  houses  proceeds 
from  contaminated  mosquitoes,  150. 

CHAPTER    VII:     WORK    IN    YELLOW    FEVER 

(CONTINUED)          .         ...         .         .154 

Gratifying  reception  of  Reed's  results  by  the  medical 
profession  in  Havana,  154 — Successful  inoculation 
of  Private  Jernigan  with  blood  of  a  yellow  fever  pa- 
tient, 156 — Experiments  showing  the  length  of  time 
which  must  elapse  between  contamination  of  a  mos- 
quito and  its  being  able  to  convey  the  disease,  157 — 
Experiments  showing  the  length  of  time  for  which 
the  mosquito  is  able  to  transmit  the  disease,  159 — 
Paper  read  by  Reed  before  the  Pan-American  Con- 


xvi  CONTENTS 

PAGE 

gress  in  Havana,  February,  1901,  161 — Return  of 
Reed  and  Carroll  to  the  United  States,  163 — Proph- 
ecy by  General  Sternberg  as  to  the  nature  of  the  spe- 
cific germ  of  yellow  fever,  164 — Experiments  of 
Loeffler  and  Frosch  in  the  foot  and  mouth  disease 
of  cattle,  165 — Carroll's  return  to  Cuba  to  continue 
experiments,  166 — Difficulties  encountered,  167 — Ex- 
periments showing  that  the  specific  germ  of  yellow 
fever  is,  in  all  probability,  ultra-microscopic,  174 — 
Obligations  of  the  Yellow  Fever  Commission  and  of 
the  world  at  large  to  Major  General  Leonard  Wood, 
Governor  of  Cuba,  180. 

CHAPTER    VIII :    PRACTICAL    APPLICATION    OF 

THE  MOSQUITO  THEORY         .         .         .182 

Extermination  of  yellow  fever  in  Havana  by  Reed's 
methods,  182 — Extermination  of  yellow  fever  in 
Laredo,  Texas,  by  Reed's  methods,  188 — Advis- 
ability of  martial  law  during  the  extermination  of 
an  epidemic,  195 — Extermination  of  yellow  fever  in 
New  Orleans  in  1904,  described  by  Dr.  J.  H. 
White,  196;  by  Mr.  Rupert  Boyce,  202;  Compara- 
tive table  of  deaths  from  yellow  fever  in  New  Or- 
leans during  different  epidemics,  204 — Reed's  views 
on  quarantine  regulations  against  yellow  fever,  205. 

CHAPTER    IX :    VALUE    OF    REED'S    WORK    TO 

THE  WORLD.         .....  210 

Epidemic  of  yellow  fever  at  Philadelphia,  in  1793, 
203 ;  extract  concerning  it  from  published  account 
by  Mathew  Carey,  211;  extracts  from  published  ac- 
count by  Dr.  Benjamin  Rush,  217 — Epidemic  of 
1878  in  Memphis,  Tenn.,  223;  extracts  concerning 
it  from  published  account  by  J.  M.  Keating,  224, 
227 — Generosity  throughout  the  United  States  to 
the  sufferers  in  Memphis,  230 — Work  of  the  How- 
ard Association,  231 — Epidemic  of  1878  in  Gre- 
nada, Miss.,  described  by  Mrs.  Lena  Warner,  233 


CONTENTS  xvii 

PAGE 

— Epidemic  of  1900  in  Havana,  described  by  Mrs. 
Warner,  235 — Mortality  during  different  epidemics, 
238 — Injury  to  national  prosperity,  239 — Expense 
of  quarantine  regulations,  241 — Slow  and  imperfect 
appreciation  of  Reed's  services  by  the  world  at  large, 
242. 

CHAPTER  X :  LIFE  AFTER  RETURN  FROM  CUBA, 

AND  DEATH. — 1901-1902       .         .         .  245 

Address  before  the  Medical  and  Chirurgical  Faculty 
of  Maryland,  April,  1901,  245 — Reed's  success  as  a 
teacher,  246- — Summer  home  in  Monterey,  249 — 
Honorary  degree  from  Harvard  University,  250 — 
Letter  to  Dr.  Theobald  Smith,  on  bacillus  icteroides 
and  the  hog-cholera  bacillus,  251 — Honorary  de- 
gree from  the  University  of  Michigan,  252 — Failing 
health,  252 — Last  illness,  253 — Operation  for  ap- 
pendicitis, 254 — Death,  256 — Funeral  services,  257 
— Monument  at  Arlington,  257 — Universal  expres- 
sion of  grief,  258 — Establishment  of  Walter  Reed 
Memorial  Association,  259. 

CHAPTER  XI :    OTHER  MEMBERS  OF  THE  YEL- 
LOW FEVER  COMMISSION         .         .         .  272 

Life  and  work  of  Dr.  Carroll,  262;  extracts  from 
published  writings  on  yellow  fever,  272-278 ;  tribute 
to  Dr.  Carroll  by  Dr.  Pilcher,  279;  list  of  inde- 
pendent publications  on  yellow  fever,  281 — Life  and 
work  of  Dr.  Lazear,  281;  death  from  experimental 
yellow  fever,  283 ;  tributes  to  his  memory,  285 ; 
tablet  erected  by  his  friends  in  the  Johns  Hopkins 
Hospital,  288 — Life  and  work  of  Dr.  Agramonte, 
288 ;  list  of  independent  publications  on  yellow  fever, 
291. 

CONCLUSION      .......  293 

BIBLIOGRAPHY  .......  299 

INDEX .         .  305 


LIST   OF   ILLUSTRATIONS 

MAJOR  WALTER  REED  IN  1901       .         .  Frontispiece 

^Etat  50. 

Facing  pagi 

WALTER  REED  IN  1874 10 

From  a  photograph  taken  in  Murfreesboro,  N.  C.   ^Etat  2  3 . 

WALTER  REED  IN  1876 30 

From  a  photograph  taken  in  Harrisonburg,  Va.     ^Etat  25. 

WALTER  REED  IN  1882 58 

From  a  photograph  taken  in  Washington,  D.  C.    JEtzt  3 1 . 

DR.  CARLOS  J.  FINLAY 114 

Who  first  promulgated  the  theory  of  the  transmission  of 
yellow  fever  by  the  mosquito. 

CAMP  LAZEAR 136 

Where  the  experiments  with  the  yellow  fever  mosquito 
were  first  carried  out,  and  the  transmission  of  the  disease 
by  this  means  proven. 

CAMP  LAZEAR 146 

Building  where  the  experiments  were  made  which  proved 
that  yellow  fever  is  not  transmitted  by  means  of  infected 
clothing  (fomites). 

JAMES  CARROLL,  M.D 166 

Member  of  the  U.  S.  A.  Yellow  Fever  Commission. 
From  a  photograph  taken  in  1901. 

MOSQUITOES 190 

MAJOR  WALTER  REED 258 

Bust  by  Hans  Schuler.  Now  in  the  library  of  the 
Surgeon- General  in  Washington. 

JESSE  W.  LAZEAR,  M.D 282 

Member  of  the  U.S.A.  Yellow  Fever  Commission,  who 
laid  down  his  life  on  the  field  of  service. 

ARISTIDES  AGRAMONTE,  M.D 288 

Member  of  the  U.  S.  A.  Yellow  Fever  Commission. 
From  a  photograph  taken  in  1902. 


WALTER  REED  AND  YELLOW  FEVER 


CHAPTER   I 

BIRTH   AND   CHILDHOOD 

1851-1876 

\Vhen  Nature  has  work  to  be  done  she  creates  a 
genius  to  do  it. — EMERSON. 

WALTER  REED,  to  whom  the  nineteenth  cen- 
tury owed  the  last  of  her  goodly  array  of  scientific 
discoveries,  was  born  in  Gloucester  County,  Vir- 
ginia, September  13,  1851. 

The  Reed  family  were  of  English  extraction, 
being  descended,  as  they  suppose,  from  Sir  Chris- 
topher Reed,  of  Chipchase  Castle,  on  the  Tyne.  A 
son  of  this  Christopher  was,  at  one  time,  Lord 
Lieutenant  of  Ireland.  Walter  Reed's  father, 
Lemuel  Sutton  Reed,  was  a  North  Carolinian  by 
birth,  though  he  passed  nearly  forty  years  of  his 
life  in  Virginia,  as  a  minister  of  the  Methodist 
Church.  His  upright  character  together  with  his 
mental  endowments  procured  him  distinction  in 
his  profession,  and  he  was  for  many  years  a 
member  of  the  Bishop's  Council.  His  first  wife, 
Walter's  mother,  was  Pharaba  White,  the  daugh- 
ter of  a  North  Carolina  planter,  who  also  came  of 
a  good  English  family.  She  was  a  loving,  loyal- 


4       WALTER   REED   AND   YELLOW   FEVER 

hearted  woman,  with  great  force  of  character,  and 
her  children  owed  much  to  her  influence. 

The  leading  traits  in  Walter  Reed's  ancestors 
on  both  sides  were  individuality  of  character  and 
desire  for  knowledge,  attributes  which  he,  him- 
self, possessed  in  no  common  degree. 

Lemuel  Reed  and  his  wife  Pharaba  had  five 
children,  a  daughter,  Laura,  who  married  Mr.  J. 
W.  Blincoe  of  Ashland,  Virginia,  and  died  in 
February,  1906,  and  four  sons,  James,  Thomas, 
Christopher,  and  Walter.  The  first  years  of  Wal- 
ter's life  were  spent  at  Farmville,  Prince  Ed- 
ward County,  and  here  when  six  years  old  he 
began  his  education  at  a  small  private  school, 
kept  by  a  Mrs.  Booker.  His  personal  appearance 
as  a  child  was  very  attractive,  and  his  manners 
were  remarkable  for  their  childish  graciousness. 
He  had  the  happy  nature  which  finds  pleasure  in 
everything,  but  he  began  early  to  manifest  the 
stronger  qualities  which  distinguished  him  in  after 
life,  namely,  force  of  character,  self-control,  a 
passionate  love  of  knowledge,  and  a  keen  sense 
of  honour.  His  brother  tells  the  story  of  a  boyish 
escapade,  which  illustrates  some  of  these  traits. 
Once,  when  still  quite  a  small  child,  Walter, 
in  company  with  some  older  boys,  made  the  rounds 
of  the  tobacco  warehouses,  then  very  numerous 
in  Farmville,  tasting  a  little  of  the  tobacco  at 


BIRTH   AND   CHILDHOOD  5 

each,  until  the  inevitable  "result  followed,  and 
Walter,  the  youngest  of  the  party,  became  so  ill 
that  his  friends  were  obliged  to  carry  him  home 
as  fast  as  they  could.  On  the  way  the  sick  boy  grew 
rapidly  worse,  and  his  friends,  thinking  he  was 
going  to  die,  became  thoroughly  frightened.  In 
great  alarm  as  to  the  judgment  to  come  they  said  to 
him  "  Promise,  Walter,  that  you  will  not  tell,  even 
if  it  kills  you."  And  Walter,  firmly  persuaded  that 
his  last  hour  was  at  hand,  promised  solemnly  that, 
even  if  it  killed  him,  the  secret  should  be  kept. 

When  he  was  about  ten  years  old  the  Civil  War 
began,  and  in  the  year  1865  Sheridan's  raiders 
swept  through  the  part  of  Virginia  where  the 
Reeds  lived,  carrying  off  with  them  all  the  live- 
stock available.  Walter  and  his  next  brother, 
Christopher,  together  with  some  other  boys  in  the 
neighbourhood,  were  sent  by  their  parents  to  hide 
their  horses.  The  boys  found  a  suitable  place  in 
the  bend  of  a  river,  far  from  any  dwelling  and 
completely  hidden  by  trees,  which  seemed  so  se- 
cure that  one  fine  morning,  leaving  the  horses  well 
tied,  they  went  for  a  swim  in  the  river.  Suddenly, 
while  they  were  thus  occupied,  a  band  of  raiders, 
guided  by  a  servant  who  had  been  considered  per- 
fectly trustworthy,  dashed  into  the  hiding-place, 
seized  the  horses,  and  took  the  boys  into  custody. 
They  were  all  too  small  to  be  worth  keeping  as 


6       WALTER   REED   AND  YELLOW   FEVER 

prisoners,  and  were,  therefore,  released,  but  not 
until  their  families  had  been  greatly  alarmed  by 
reports  of  their  seizure.  The  horses,  of  course, 
were  gone  forever. 

In  1866  the  Reed  family  moved  to  Charlottes- 
ville,  and  there  Walter,  now  fifteen  years  of  age, 
was  sent  to  a  private  school  kept  by  a  Mr.  Abbott, 
a  graduate  of  the  University  of  Virginia.  His 
education  had  been  carried  on  without  interrup- 
tion up  to  this  time,  except  for  one  year  during 
the  Civil  War,  when  all  the  schools  in  his  neigh- 
bourhood were  closed,  and  he  was  well  advanced 
for  his  age,  especially  in  history  and  literature; 
but,  strange  to  say,  he  does  not  seem  to  have  shown 
any  marked  aptitude  or  taste  for  science  during 
his  boyhood.  He  remained  with  Mr.  Abbott  for 
two  sessions  and  then  entered  the  university,  by 
special  dispensation,  as  he  was  only  sixteen,  which 
was  under  the  required  age.  Notwithstanding  his 
extreme  youth,  his  work  was  always  good  and  he 
held  a  high  place  in  all  his  classes.  It  was  his 
earnest  wish  to  go  through  the  university,  but  as 
two  of  his  brothers  were  already  studying  there 
with  that  intention,  and  his  father's  means  were 
limited,  he  soon  realised  that  it  would  be  impossi- 
ble for  him  to  take  the  entire  course.  He  applied, 
therefore,  in  person  to  the  faculty  to  be  certificated 
in  the  studies  he  had  pursued,  but  this  request 


BIRTH   AND   CHILDHOOD  7 

was  refused  on  the  ground  that  he  was  under  age. 
He  then  inquired  whether  he  would  be  allowed  to 
take  the  degree  of  doctor  of  medicine  if  he  could 
pass  the  examinations.  To  this  the  faculty  silently 
assented,  thinking  (as  one  of  them  afterwards  told 
Reed's  brother)  that  it  was  a  safe  promise,  for 
the  undertaking  was  an  impossibility.  Reed  then 
turned  to  Dr.  Maupin,  the  chairman,  and  said, 
"  Doctor,  you  have  heard  what  these  gentlemen 
say.  Will  you  see  that  I  have  my  degree  as  M.  D. 
if  I  make  the  required  standard?"  Dr.  Maupin 
replied  that  he  would,  and  Reed,  bowing  to  the 
faculty,  said,  "  Gentlemen,  I  hold  you  to  your 
promise,"  and  left  the  room.  The  friend  who  re- 
lated this  incident  to  Christopher  Reed  said  that 
Walter's  self-restraint  and  dignity,  remarkable  in 
a  boy  of  sixteen,  made  a  marked  impression  on 
those  who  were  present. 

Reed  at  once  began  his  medical  studies  and 
graduated  nine  months  later,  in  the  summer  of 
1869,  standing  third  in  his  class.  Dr.  Maupin,  in 
presenting  him  his  diploma,  said  that  he  was  the 
youngest  student  ever  graduated  from  the  Medical 
School  at  Charlottesville,  but  that  as  he  had  ful- 
filled every  requirement,  the  faculty  were  bound  in 
honour  to  give  him  his  degree. 

Dr.  A.  R.  Buckmaster,  recently  professor  of  ob- 
stetrics and  practical  medicine  at  the  University 


8       WALTER   REED   AND   YELLOW   FEVER 

of  Virginia,  writes  me  regarding  Reed's  career  at 
college  as  follows : 

Walter  Reed  was  at  the  University  of  Virginia 
two  sessions.  In  1867  ne  to°k  Latin,  Greek,  English 
literature,  and  another  study  in  the  academic  depart- 
ment. In  1868  he  studied  medicine  and  was  graduated 
after  one  year's  work.  This  in  itself  shows  that  he  was 
an  unusual  man.  There  are  quite  a  number  of  men 
who  succeeded  in  the  past  in  obtaining  the  degree  of 
M.  D.  in  one  year,  but  in  many  of  these  cases  they 
had  studied  one  or  two  years  before  coming  here.  The 
standard  was  very  high  and  no  man  could  have  reached 
it  unless  he  was  a  very  clever  student.  ...  I  do 
not  think  I  exaggerate  when  I  say  that  a  large  propor- 
tion of  the  men  who  won  the  degree  after  a  single 
year's  work  became  physical  wrecks.  So  you  see  that 
in  earning  his  degree  he  proved  himself  above  the 
average. 

Walter's  brother,  Christopher,  who  was  his 
roommate  during  this  period  of  his  life,  testifies 
to  the  earnestness  and  enthusiasm  with  which  he 
pursued  his  studies,  at  one  time  allowing  himself 
only  three  or  four  hours'  sleep  out  of  the  twenty- 
four.  A  few  months  after  his  graduation  he  went  to 
New  York  and  matriculated  as  a  medical  student 
at  the  Bellevue  Hospital  Medical  College,  where 
he  received  the  degree  of  M.  D.  a  year  later.  This 
was  Reed's  first  visit  to  a  large  city,  and  he  made 
the  most  of  his  time  in  other  ways  than  the  study 


BIRTH   AND   CHILDHOOD  ,      9 

of  medicine.  His  love  of  intellectual  pursuits 
made  him  seize  every  opportunity  to  hear  good 
speakers  on  literature,  science,  and  even  law,  as 
well  as  to  enjoy  all  that  was  best  in  music  or  the 
drama. 

After  finishing  his  course  at  Bellevue,  Dr.  Reed 
was  attached  to  several  of  the  hospitals  in  New 
York  and  Brooklyn,  amongst  these  the  King's 
County  Hospital,  where  he  was  interne.  He  was 
also  at  the  hospital  on  Randall's  Island,  where 
he  went  especially  to  study  children's  diseases. 
'A  little  later  he  was  appointed  district  physi- 
cian to  one  of  the  poorest  districts  in  New 
York,  and  was  thus  brought  into  daily  contact, 
for  the  first  time,  with  all  the  misery  arising 
from  poverty  and  vice  in  a  large  city,  a  phase 
of  life  which  affected  him  most  deeply.  His 
brother,  Christopher,  by  this  time  practising  law, 
was  now  again  his  roommate,  and  he  relates  how 
one  night,  when  he  was  In  bed  and  apparently 
asleep,  Walter  returned  late  from  some  pro- 
fessional visits,  and  after  standing  for  a  time  at 
the  window  looking  down  upon  the  great  city  be- 
low him,  said  slowly,  as  one  unobserved  and 
speaking  to  himself:  "Woe  unto  thee,  Chorazin, 
woe  unto  thee,  Bethsaida,  for  if  the  mighty  works 
which  were  done  in  you  had  been  done  in  Tyre 
and  Sidon,  they  would  long  ago  have  repented 


io     WALTER   REED   AND   YELLOW   FEVER 

in  sackcloth  and  ashes."  Then,  kneeling  down  by 
the  bedside,  he  repeated  the  Lord's  Prayer  slowly 
and  with  deep  emotion.  Christopher  Reed  gave 
no  sign  of  observing  what  passed,  and  the  incident 
was  never  mentioned  between  the  brothers. 

While  at  one  of  the  Brooklyn  hospitals  Dr. 
Reed  attracted  the  attention  of  Dr.  Joseph  C. 
Hutchison,  then  the  leading  physician  and  sur- 
geon of  Brooklyn,  and  through  his  influence  was 
appointed  one  of  the  five  inspectors  on  the  Brook- 
lyn Board  of  Health.  At  this  time  Reed  was  only 
twenty-two  years  of  age,  but  he  had  already  es- 
tablished his  reputation  as  a  young  man  of  the 
highest  talents,  especially  distinguished  for  his 
skill  in  surgery.  When  on  the  Board  of  Health 
he  came  home  one  day  greatly  depressed,  and  on 
his  brother's  asking  the  reason,  he  replied,  "  To- 
day an  elegant  equipage  with  coachman  and  foot- 
man stopped  in  front  of  my  office  and  a  finely 
dressed  gentleman  came  in,  introducing  himself 

as  Dr. ,  and  saying  that  he  wished  to  report 

the  death  of  a  child.  He  was  so  grossly  ignorant 
that  he  could  not  use  medical  nomenclature  cor- 
rectly, nor  even  state  symptoms.  I  then  asked  him 
if  he  did  not  think  it  was  such  a  disease  [using  the 
Latin  term],  and  he  answered  'Yes,'  repeating  the 
word  backward.  Yet  this  man  has  the  leading 
practice  in  this  part  of  Brooklyn,  although  he  is 


WALTER    REED    IN     1874 
From  a  photograph  taken  in  Murfreesboro,  N.  C.      ^Etat  23 


BIRTH   AND   CHILDHOOD  n 

a  first-class  quack.  I  am  disgusted  and  I  should 
like  to  give  up  my  profession." 

In  June,  1874,  Dr.  Reed  paid  a  visit  to  his 
father,  who  was  then  living  in  the  little  town 
of  Murfreesboro,  in  North  Carolina.  Walter's 
mother  had  died  when  he  was  a  boy,  and  his  father 
was  now  married  again  to  a  Mrs.  Kyle,  formerly 
Miss  Mary  Byrd,  of  Harrisonburg,  Virginia. 
There  was  only  one  child  of  this  second  marriage, 
a  daughter  Annie,  now  Mrs.  D.  T.  Elam  of  Farm- 
ville,  Virginia. 

It  was  during  this  visit  to  Murfreesboro  that 
Dr.  Reed  made  the  acquaintance  of  his  future 
wife,  Miss  Emilie  Lawrence.  Miss  Lawrence's 
father,  John  Vaughan  Lawrence,  was  a  North 
Carolina  planter  of  means  and  influence;  he  was 
descended  from  an  English  John  Lawrence,  who 
came  to  this  country  from  the  west  of  England  in 
1636  and  settled  in  Watertown,  Massachusetts. 
Her  mother,  Hannah  Rea,  belonged  to  another 
good  old  English  family,  which  settled  in  Salem, 
Massachusetts,  in  1630. 

On  Dr.  Reed's  return  to  New  York  he  began  a 
correspondence  with  Miss  Lawrence,  which  af- 
fords an  interesting  insight  into  his  thoughts  and 
actions  at  this  period  of  his  life.  It  was  during 
this  year,  1874,  that  he  made  up  his  mind  to  give 
up  the  idea  of  general  practice  and  to  enter  the 


12      WALTER   REED   AND   YELLOW   FEVER 

army  as  a  surgeon.  His  reasons  for  this  determi- 
nation, as  given  to  his  brother,  were  that  success 
in  general  practice  depended  largely  on  social  con- 
nection, the  possession  of  wealth,  and  influential 
friends;  and  that  as  he  was  unable  to  rely  upon 
these  sources  for  advancement,  he  believed  he 
had  better  take  up  a  line  where  his  future  was 
secure  and  he  could  pursue  scientific  research. 
Long  afterward,  however,  he  admitted  to  his  wife 
that  his  resolution  to  abandon  general  practice 
and  enter  the  army  arose  from  his  desire  to  possess 
an  assured  competency  as  soon  as  possible  in  order 
that  he  might  feel  justified  in  asking  her  to  marry 
him,  and,  indeed,  anyone  who  reads  the  following 
letter,  which  was  one  of  the  earliest  he  wrote  her, 
will  see  plainly  how  much  he  was  actuated  by  this 
motive. 

BROOKLYN,  July  18,  1874. 

I  have  been  recently  contemplating  a  departure 
from  Brooklyn.  My  friends  will  consider  me  unwise 
in  this,  perhaps,  but  after  due  attention  given  to  the 
matter  I  believe  I  will  be  justified  in  so  doing.  I  have 
about  made  up  my  mind  to  make  a  strenuous  effort  to 
enter  the  Medical  Corps  of  the  United  States  Army. 
The  Examining  Board,  which  has  not  met  before  in 
six  (6)  years,  assembles  in  New  York  City,  August  4, 
next.  I  should  not  desire  to  remain  longer  than  3  or 
4  years  at  the  outside.  And  now  for  reasons.  In  the 
first  place,  the  Board  of  Health  are  requiring  more 


BIRTH   AND   CHILDHOOD  13 

work  of  the  Inspectors  every  day  and  to  such  a  degree 
that  the  idea  of  private  practice  cannot  be  thought  of 
— in  fact  they  desire  that  the  whole  of  an  Inspector's 
time  be  devoted  to  the  interest  of  the  Health  of  his 
District.  This  is,  doubtless,  right  enough  in  a  strict 
interpretation,  but  it  is  such  a  "  new  departure  "  that  I 
for  one,  fail  to  appreciate  it.  Secondly,  these  great 
cities  have  lost  the  fascination  which  formerly  held  me 
so  fast.  Four  years  ago,  I  would  have  remained  here 
"  though  the  heavens  fall."  I  gave  my  hopes  and  am- 
bitions a  free  rein  and  applied  the  whip  and  spur  un- 
sparingly. To  live  in  any  other  place  than  New  York 
or  Brooklyn  never  entered  my  head,  and  if  a  person 
had  advised  me  to  go  to  some  small  town,  I  would 
have  certified  to  his  insanity.  To  such  an  extent  does 
our  folly  mislead  us!  But  since  then  a  few  more 
springs  have  come  and  gone,  and  though  no  grey  hairs 
adorn  my  head,  I  have  become  a  little  wiser,  I  hope. 
I  have  carefully  noted  the  success  or  failure  of  those 
around  me  and  I  have  watched  them  in  their  sorrows 
and  joys.  Yet,  during  this  time  I  have  been  unable  to 
discover  the  great  advantages  of  living  in  Metro- 
politan cities,  except  it  be  in  the  "  wear  and  tear."  It 
is  true  I  never  worked  harder,  but  I  can't  say  that  it 
has  brought  me  an  equal  amount  of  comfort.  I  have 
still  a  third  reason.  Having  entered  my  profession 
about  4  years  earlier  than  is  the  custom,  I  have  ex- 
perienced all  the  troubles  of  a  youthful  aspirant  for 
honours.  As  long  as  my  success  depended  upon  actual 
knowledge  and  experience,  I  managed  to  overcome  all 
obstacles,  but  the  moment  that  I  entered  upon  the  race 
of  life  I  at  once  found  out  the  disadvantages  of  a 


H      WALTER   REED   AND    YELLOW   FEVER 

youthful  appearance.  It  is  a  remarkable  fact  that  a 
man's  success  during  the  first  decade  depends  more 
upon  his  beard  than  his  brains.  And  inasmuch  as  I 
could  boast  of  none  of  the  former,  and  but  an  in- 
finitesimal quantity  of  the  latter,  I  found  "  Jordan  to 
be  a  hard  road  to  travel."  Yet,  notwithstanding  these 
many  drawbacks,  my  success  has  been  greater  than  I 
expected,  and  unless  I  can  obtain  the  sanction  of  home- 
folks,  I  will  not  leave.  My  stay  in  these  cities  has  done 
me  an  incomparable  good.  By  it  I  have  obtained  an 
extensive  hospital  and  sanitary  experience  which  is  worth 
to  me  more  than  I  can  now  estimate.  It  has  also  given 
me  a  truer  insight  into  human  nature  than  I  would  have 
acquired  in  an  equal  number  of  years  elsewhere,  while  it 
has  added  to  my  respect  for  truth  and  morality.  So 
that  I  count  myself  more  than  fortunate  so  far.  On 
the  other  hand,  I  had  thought  that  as  I  have  no 
anxiety  to  plunge  at  once  into  the  cares  of  life,  a  few 
years  spent  in  travelling  from  one  part  of  the  country 
to  another  would  be  of  profit  to  me.  Of  course  all 
depends  upon  my  ability  to  pass  the  examination,  which 
is  a  very  rigid  one  (I  must  confess  I  dread  it).  If  at 
the  end  of  that  time  (3  or  4  years  hence)  I  could 
find  some  fair  damsel  who  was  foolish  enough  to  trust 

me,  I  think  I  would  get married,  and  settle  down 

to  sober  work  for  the  rest  of  my  days  in  some  small 
city  where  one  could  enjoy  the  advantages  of  a  city  and 
at  the  same  time  not  feel  as  if  lost.  For  in  what  does 
life  consist?  What  is  its  true  philosophy?  Is  it  to 
win  the  applause  of  the  rabble,  or  to  sit  in  high  places? 
Do  we  not  arrive  nearer  to  true  happiness  in  striving 
to  accept  what  Divine  Wisdom  allots  to  us — doing  all 
we  can  to  assist  our  fellowmen  in  being  happy  and 


BIRTH   AND   CHILDHOOD  15 

submitting  uncomplainingly  to  the  will  of  Him  who 
gave  us  breath  and  life?  Ever  remembering  that  "  he 
that  hurnbleth  himself  shall  be  exalted." 

Reed's  resolution  once  taken,  he  began  immedi- 
ately to  prepare  for  the  necessary  examination  with 
characteristic  thoroughness.  A  few  years  spent  in 
active  life  without  systematic  application  to  study 
always  renders  the  resumption  of  it  difficult,  and 
Reed's  case  was  no  exception.  He  writes  about  the 
examination  to  Miss  Lawrence  as  follows : 

BROOKLYN,  Aug.  12,  1874. 

If  I  appear  amazingly  stupid  as  I  proceed,  please 
remember  that  my  mind  has  been  racked  during  the 
past  day  or  two  with  the  "  atomic  theory  "  and  the  "  law 
of  equivalents  "  so  that  peradventure  whatsoever  I  shall 
write  will  not  contain  one  atom  of  news  or  be  equiva- 
lent to  your  loss  of  time  in  reading  it.  From  early 
morning  till  far  into  the  hours  of  the  night  I  must 
needs  be  plodding  along  through  dry  dusty  details  and 
charging  my  memory  with  a  thousand  items  which  may 
possibly  prove  useful  to  me  in  the  coming  ordeal.  The 
truth  is  I  was  not  aware  of  how  much  I  had  forgotten 
and  in  how  many  places  the  rust  had  accumulated  till 
I  began  a  careful  review.  The  more  I  read,  the  greater 
the  task  looms  up  before  me  till  I  stand  appalled  at  the 
work  that  must  be  done,  and  almost  think  all  I  ever 
knew  has  forsaken  me.  But  one  thing  I  will  not  per- 
mit to  forsake  me  is  my  courage,  and  if  effort  will 
avail  anything,  it  shall  not  fail  me  in  this  case.  I  went 
over  to  New  York  a  few  days  ago  and  had  a  long 


1 6     WALTER   REED   AND   YELLOW   FEVER 

talk  with  the  Recorder  of  the  Examining  Board.  To 
my  utter  astonishment  he  informed  me  that  candidates 
must  stand  an  examination  in  Latin,  Greek,  mathe- 
matics, and  history,  in  addition  to  medical  subjects. 
Horror  of  Horrors!  Imagine  me  conjugating  an  ir- 
regular verb,  or  telling  what  x-fy  equals,  or  what  year 
Rome  was  founded,  or  the  battle  of  Marathon  fought. 
Why  the  thing  is  impossible,  I  shall  utterly  fail.  Add 
to  this  that  each  applicant  is  examined  five  hours  each 
day  for  six  successive  days — thirty  hours'  questioning 
— and,  to  cap  the  climax,  there  are  more  than  500  ap- 
plicants for  less  than  30  vacancies?  The  very  thought 
of  it  makes  me  dizzy.  Think  of  my  condition  and 
pity  me,  for  I  need  all  the  sympathy  of  all  my  friends. 

The  strain  of  such  close  application  soon  told 
upon  Reed's  health  and  spirits.  He  became  much 
depressed,  and  about  a  month  later  he  writes : 

BROOKLYN,  Sept.  17,  1874. 

I  owe  you  an  apology  for  my  long  delay  in  an- 
swering your  last  letter.  I  would  have  written  you 
promptly  had  I  not  been  debarred  from  doing  so  by 
severe  sickness.  During  three  long  weeks  I  have  been 
confined  to  my  room  and  during  the  greater  part  of 
this  time  I  was  scarcely  able  to  raise  my  head  from 
the  pillow.  Hence  I  have,  of  necessity,  been  compelled 
to  forego  executing  many  plans  which  I  had  projected, 
no  one  of  which  gave  me  more  reason  for  regret  than 
my  inability  to  write  to  you.  Doubtless  my  own  folly 
was  the  cause  of  my  indisposition.  I  had  been  trying 
to  do  more  than  my  strength  could  bear.  It  may  be 


BIRTH   AND    CHILDHOOD  17 

that  I  cannot  do  as  much  brainwork  in  the  same  length 
of  time  as  I  could  do  in  my  younger  days ;  or,  perhaps, 
a  more  correct  statement  would  be  that  I  have  for  so 
long  a  time  abandoned  the  habit  of  hard,  continuous 
application  as  to  make  it  somewhat  difficult,  if  not  a 
matter  attended  with  danger,  to  return  into  the  traces 
quickly.  I  remember  the  time  when  I  could  safely  study 
as  much  as  20  hours  uninterruptedly  day  after  day, 
and  not  experience  any  bad  effect  from  it,  but  I  presume 
that  time  shall  return  no  more.  .  .  .  But,  really, 
there  is  a  charm  in  study  which  I  fain  must  acknowledge. 
Let  me  become  interested  with  what  the  author  is  say- 
ing, and  it  is  a  difficult  matter  to  break  the  spell,  nor  do 
I  cease  to  toil  until  my  weary  senses  warn  me  that  nature 
is  well-nigh  exhausted.  .  .  .  Perhaps  I  decide  to 
dash  aside  the  book  and  for  once  yield  to  refreshing 
sleep,  but  quicker  than  ever  winged  lightning  cleaved 
heaven's  vault  the  thought  flashes  through  my  mind 
that  there  are  a  thousand  things  in  that  cast-aside  vol- 
ume of  which  I  am  ignorant,  a  thousand  unanswerable 
questions  that  may  rise  up  against  me  in  the  day  of  my 
examination,  to  humble  and  mortify  me.  Wracked  with 
a  thousand  fears,  I  tear  open  the  book  and  eagerly  scan 
its  pages,  determined  to  exhaust  every  effort,  and,  if 
need  be,  to  suffer  death  rather  than  defeat.  This  is 
what  I  have  done  and  the  result  is  sickness  and  mental 
paralysis,  and  it  is  what  I  shall  not  dare  to  repeat.  Too 
happy  in  having  regained  my  strength,  I  will  see  to  it 
that  I  do  not  precipitate  myself  into  my  former  unhappy 
condition.  This  I  can  do  the  more  easily  as  I  have  now 
abundance  of  time  in  which  to  review  my  studies.  A  few 
days  ago  I  received  a  notice  from  the  Pres.  Army  Exam- 


1 8      WALTER   REED   AND  YELLOW   FEVER 

ination  Board  that  I  would  not  have  to  stand  my  exam- 
ination till  January  i8th,  1875.  Of  course  this  suits  me 
exactly." 

In  spite  of  the  relief  afforded  by  the  postpone- 
ment of  his  examination,  Reed  continued,  as  his 
letters  show,  to  be  much  oppressed  by  his  work, 
and  he  writes  again  two  months  later : 

BROOKLYN,  Nov.  3rd,  1874. 

My  second  excuse  for  not  writing  is  but  a  repeti- 
tion of  the  same  old  story — ill-health.  Alas!  I  am  so 
harassed.  What  to  do  surpasses  the  infinite  of  thought. 
I  must  study — not  a  moment  to  lose — and  it  is  this 
same  studying  that  has  all  along  delayed  my  conva- 
lescence. Sick!  Why,  I  haven't  drawn  an  unsound 
breath  for  years.  But  now,  when  I  need  all  my 
strength,  lo!  it  fails  me.  .  .  .  Still  I  believe  that 
when  a  person  determines  to  accomplish  an  end,  that 
he  should  put  forth  all  honest  effort,  nor  turn  aside, 
unless  for  the  best  of  reasons ;  and  if  he  meets  with  de- 
feat let  him  accept  it  like  a  man,  remembering  that 
many  better  men  have  found  themselves  in  a  like  situa- 
tion. At  all  events  I  shall  pursue  my  course  until  every 
prop  is  knocked  away  from  under  me.  Sufficient  to  the 
day  is  the  evil  thereof. 

The  morbid  dread  of  failure  arising  from  bodily 
weakness  passed  away  as  health  returned,  and  in 
January,  1875,  Reed  writes  cheerfully  of  his  pros- 
pects. A  month  later,  in  February,  1875,  after  a 


BIRTH   AND   CHILDHOOD  19 

second  postponement,  he  passed  his  examinations 
brilliantly,  and  this  event  was  shortly  followed  by 
his  engagement  to  Miss  Lawrence.  In  the  follow- 
ing June  he  received  his  commission  as  Assistant 
Surgeon,  with  the  rank  of  First  Lieutenant. 

His  first  station  was  Willet's  Point,  New  York 
harbour,  whence  he  writes  to  Miss  Lawrence  as 
follows : 

WILLET'S  POINT,  Sept.  15,  1875. 

Would  you,  could  you  believe  that  I  would  allow  my 
twenty-fifth  birthday  to  pass  without  so  much  as  think- 
ing of  it  during  the  whole  day.  The  very  day  on  which 
I  wrote  you  last  I  was  twenty-four  years  old  (just 
think  of  it),  and  yet  I  was  totally  ignorant  of  it.  Of 
course  I  felt  the  weight  of  years  more  than  usual  on 
that  day,  but  I  could  not  account  for  it.  Suddenly  on 
Tuesday  the  14,  it  occurred  to  me  that  I  was  one  year 
older  and  immediately  the  cause  of  my  fatigue  flashed 
across  my  mind.  It  is  too  late  for  me  to  grow  eloquent 
over  the  subject  (for  I  had  intended  to  say  something 
suitable  to  such  an  occasion),  since  the  champagne  has 
lost  its  effervescence,  but  still  I  can  not  permit  my  birth- 
day to  pass  without  some  remarks. 

Alas,  my  twenty-fifth  birthday  has  passed  and  what 
have  I  to  show  for  it!  What  good  deeds  have  I 
done  that  merit  approbation!  How  negligent  and 
wayward  I  have  been!  What  golden  moments  of  op- 
portunity have  come  and  gone,  all  unheeded!  As  I 
look  back  over  my  past  life  to-night,  but  few  thoughts 
occur  to  me  such  as  cause  my  bosom  to  swell  with 


20     WALTER   REED   AND   YELLOW   FEVER 

honest  pride.  Ah,  how  many  heart  pangs  have  I  not 
suffered  during  these  few  years  of  my  life?  Are  there 
as  many  more  in  store  for  me  in  the  future?  No! 
I'll  not  believe  it.  I  know  there  will  be  griefs  and 
disappointments,  but  will  you  not  share  them  with 
me?  .  .  .  Do  not  think  that  I  fail  to  appreciate 
the  many  sacrifices  that  you  make  in  confiding  your 
future  to  my  care.  The  remembrance  of  them  is 
daily  present  with  me  and  serves  to  increase  my  dili- 
gence. 

In  the  following  December  Miss  Lawrence  lost 
a  little  nephew  to  whom  she  was  much  attached, 
and  in  the  letter  written  to  her  after  hearing  of  the 
child's  death,  Reed  expresses  his  sympathy  and 
makes  mention  of  his  religious  faith  with  touching 
simplicity.  The  words  referring  to  the  possibili- 
ties of  his  own  future  assume  a  new  significance 
now  that  the  work  then  in  store  for  him  is  ac- 
complished. 

WILLET'S  POINT,  Dec.  20th,  1875. 

Your  letter  of  the  i6th  is  just  at  hand.  I  had 
hoped  and  prayed  that  when  your  next  letter  came  it 
would  bring  me  the  glad  tidings  that  your  little  nephew 
had  been  spared  and  restored  to  the  love  of  his  parents 
and  friends.  Alas,  while  I  prayed  that  his  life  might 
be  prolonged  to  many  years  of  usefulness,  he  had  al- 
ready departed  for  a  better  and  a  brighter  home. 

.  .  little  pilgrim  of  a  few  days  what  sad,  sad 
hours  you  have  escaped!  God  removed  you  ere  you 


BIRTH   AND   CHILDHOOD  21 

had  experienced  the  cruel  bufferings  of  this  world  and 
while  thy  heart  knew  no  evil.  And  for  this  ought  we 
not  rather  to  bless  His  Holy  Name  than  yield  to  un- 
availing grief?  When  I  see  the  little  lambs  hastening 
home,  I  would  not  call  them  back,  for  though  I  have 
scarcely  begun  life,  I  have  known  what  sorrow  is  and 
felt  the  weight  of  care.  Do  not  think  that  I  shrink 
from  meeting  life's  realities.  No,  no.  That  would 
display  a  lack  of  courage  and  a  want  of  faith.  Nor 
that  I  would  not  wish  to  live  many  years  yet.  It  may 
be  that  God  in  his  all-wise  Providence  has  some  wise 
purpose  for  me,  humble  as  I  am,  to  fulfil,  and  shall  I 
shrink  from  it? 

In  a  letter  shortly  preceding  this  one,  when 
speaking  of  the  delight  with  which  he  looked  for- 
ward to  a  visit  to  Murfreesboro,  Dr.  Reed  writes: 

Think  if  anything  should  occur  to  interrupt  my  going, 
such  for  instance  as  my  being  ordered  to  the  Far 
West  before  the  time  arrives.  Uncle  Sam  couldn't  be 
so  hard-hearted  as  to  order  a  poor  fellow  away.  He 
is  too  good-natured  an  old  chap  to  do  such  an  act.  At 
least  we  will  hope  so. 

Uncle  Sam  justified  this  good  opinion  for  the 
moment,  but  a  little  later  Reed's  worst  forebodings 
were  fulfilled.  In  the  spring  of  1876,  when  his 
marriage  was  shortly  to  take  place,  and  all  ar- 
rangements for  it  were  made,  he  was  suddenly 
ordered  to  duty  in  Arizona.  This  was  a  great  blow 


22      WALTER   REED   AND   YELLOW   FEVER 

to  him.  To  postpone  his  marriage  indefinitely  was 
not  to  be  thought  of,  yet  he  could  not  bear  to  take 
a  young  wife  out  to  a  rough,  semi-civilised  coun- 
try with  which  he  was  not  even  himself  familiar. 
He  decided  to  seek  an  interview  with  the  Surgeon- 
,|General  and  to  find  out  whether,  if  he  went  to  Ari- 
zona at  the  time  appointed,  he  would  be  able  to 
obtain  leave  in  the  course  of  a  few  months  to 
return  for  his  marriage.  This  was  a  step  that  re- 
quired all  his  courage,  for  to  a  lieutenant  in  the 
Army  Medical  Corps  his  chief  is  an  all-power- 
ful being,  holding  his  subordinates  entirely  in  his 
power,  and  able  to  exalt  or  debase  them  at  his 
will.  There  was  no  help  for  it,  however,  and 
Reed  went  to  Washington. 

His  heart  sank  within  him  when  he  was  ushered 
into  the  presence,  and  after  introducing  himself, 
was  ordered  in  a  peremptory  manner  to  "  Sit 
down."  Next  came  the  abrupt  question,  "  What 
do  you  want?"  "I  would  like  to  know,  General, 
if  I  can  get  a  leave  while  I  am  in  Arizona.  I  am 
engaged  to  be  married  and  should  want  to  re- 
turn." The  General's  voice  became  gruffer  still 
and  his  face  more  stern  as  he  replied,  "  Young 
man,  if  you  don't  want  to  go  to  Arizona,  resign 
from  the  service."  At  this  Reed's  spirit  returned, 
he  lost  all  timidity,  and  answered  fearlessly  as 
man  to  man,  "  General,  I  did  not  labour  for  my 


BIRTH   AND   CHILDHOOD  23 

commission  with  all  the  will  which  I  did  to  throw 
it  away  hastily,  nor  can  you  deprive  me  of  it  till 
I  act  so  unworthily  as  to  cause  dismissal."  The 
old  man's  manner  changed  at  once.  He  was  evi- 
dently pleased  by  his  young  subordinate's  spirit, 
and  he  answered  kindly,  "  Have  a  cigar,  Dr.  Reed, 
and  let  us  talk  it  over."  At  the  end  of  the  inter- 
view, he  gave  his  ultimatum  thus:  "Don't  marry 
now.  Go  to  Arizona.  There  is  no  doubt  some 
officer  will  become  insane  before  long.  You  can 
bring  him  East,  and  there  will  be  the  chance  for 
your  wedding."  In  after  years  Dr.  Reed  often 
laughed  at  the  patience  he  would  have  been  called 
upon  to  exercise  if  he  had  followed  the  Surgeon- 
General's  advice,  for  he  had  been  married  thirteen 
years  before  he  was  ordered  to  Washington  to 
escort  an  officer  to  St.  Elizabeth's  Asylum. 

As  no  change  in  the  situation  could  be  hoped 
for,  the  arrangements  for  the  wedding  were  has- 
tened, and  it  took  place  on  April  25,  1876.  Two 
weeks  later  Dr.  Reed  went  to  his  command  alone, 
wishing  to  ascertain  what  hardships  would  have 
to  be  faced,  and  also  what  arrangements  could  be 
made  for  his  wife's  comfort  before  she  joined  him. 


CHAPTER  II 

FRONTIER   LIFE 
1876-1889 

Es  bildet  ein  Talent  sich  in  der  Stille. 

— GOETHE. 

IN  May,  1876,  Dr.  Reed  went  to  his  post  in  Ari- 
zona, there  to  continue  a  garrison  life  which  lasted 
eighteen  years,  the  greater  part  of  it  being  spent  in 
the  Far  West 

In  the  following  October  his  wife  set  forth 
from  Norfolk,  Virginia,  to  join  him.  At  that  time, 
when  facilities  for  travel  were  not  what  they  are 
now,  such  a  journey  was  a  great  undertaking  for 
a  girl  of  twenty,  who  had  never  travelled  alone 
for  any  distance  before.  Mrs.  Reed's  courage  was, 
moreover,  tried  by  several  emergencies,  such  as  a 
blizzard  and  a  collision  with  a  westward  bound 
train.  At  the  end  of  a  week,  however,  she  reached 
San  Francisco,  where  Dr.  Reed  joined  her,  and 
they  started  for  Fort  Lowell,  Arizona,  a  journey 
of  twenty-two  days,  in  an  army  waggon  over  the 
roughest  kind  of  roads,  and  among  the  most  prim- 
itive conditions.  Some  idea  of  the  difficulties 
which  beset  their  way  may  be  formed  from  the  fol- 

24 


FRONTIER   LIFE  25 

lowing  extract  taken  from  a  letter  from  Dr.  Reed 
to  his  wife's  sister,  Mrs.  J.  N.  Harrell: 

We  left  San  Diego,  November  15,  '76,  at  2  P.  M. 
My  waggon,  loaded  with  our  baggage,  had  left  at  I 
p.  M.  I  had  been  told,  on  careful  inquiry,  that  the  dis- 
tance to  the  first  station  was  16  to  20  miles,  which 
being  the  case,  my  waggon  should  have  made  it  by  6 
p.  M.  and  my  ambulance  by  5  P.  M.  But  "  the  best  laid 
plans  of  mice,"  etc.,  etc.  I  soon  found  that  the  road 
was  horribly  rough  and  by  5  P.  M.  I  had  not  made 
more  than  10  miles,  for  I  had  to  walk  my  team  every 
step.  By  this  time  the  sun  was  set  and  as  there  was 
no  moon,  it  soon  became  so  very  dark  that  we  could 
barely  keep  to  the  road.  I  had  already  overtaken  and 
passed  my  waggon.  By  seven  o'clock  P.  M.  it  had 
turned  quite  cold.  I  had  Emilie  put  on  her  waterproof; 
I  also  had  two  overcoats,  one  of  which  I  wrapped  her 
feet  snugly  in  and  the  other  I  had  her  put  on,  so  that 
she  was  thoroughly  prepared  for  the  cold.  I  then  told 
the  driver  to  go  very  carefully,  and  to  watch  for  any 
lights,  so  that  we  would  be  certain  not  to  pass  the  sta- 
tion in  the  dark,  for  I  thought  it  must  be  near  by.  On 
we  went,  keeping  a  good  watch  on  each  side,  till  my 
watch  marked  9  P.  M.,  and  still  no  station.  Emilie  be- 
gan to  ask  "  How  much  further  have  we  got  to  go?  " 
quite  frequently,  and  I  could  only  answer,  "  It  can't  be 
far."  A  few  minutes  later  and  we  espied  a  light  ahead 
and  to  the  right  of  our  road.  I  now  told  Emilie  to 
pluck  up  her  courage  as  we  should  soon  reach  the  sta- 
tion. However,  when  we  had  gone  about  half  a  mile, 
we  found  that  the  road  left  the  light  to  our  right,  and 


hence  I  was  much  perplexed  to  know  whether  it  was  the 
station  or  not.  I  told  the  driver  to  go  over  and  ascer- 
tain. He  returned  in  about  20  minutes  and  stated  that 
it  was  not  the  station !  He  said  that  the  owner  was  very 
anxious  that  we  should  stay  over,  night  with  him,  al- 
though his  accommodations  were  not  the  best  in  the 
world.  He  had  neither  hay  nor  grain  for  my  animals; 
in  fact,  he  could  not  furnish  us  even  a  bed  to  sleep  in, 
inasmuch  as  he  and  his  old  lady  had  had  a  "  family 
jar  "  on  that  very  day,  which  had  ended  in  the  old 
lady  walking  off  with  the  bed  and  bedding  and  leaving 
him  the  house.  I  could  but  feel  extremely  grateful  to 
this  gentleman  for  his  kind  proffer,  but  nevertheless 
concluded  to  decline  his  hospitality  till  some  future  day. 
Our  search  thus  fruitlessly  terminated,  we  again 
began  our  weary  march,  Emilie,  in  the  meantime,  let- 
ting fall  several  very  small  tears.  Bless  her  darling 
heart!  I  must  give  her  credit  for  great  bravery  on 
this,  her  first  night  in  an  ambulance.  I'm  afraid,  if 
there  had  been  a  stone  wall  near  by  /  should  have 
brought  my  head  in  violent  contact  with  it.  But  there 
was  nothing  to  be  done  but  to  go  on.  On,  on,  we 
plodded,  so  slow,  so  slow,  for  it  was  very  dark  and 
the  road  horribly  rough.  Several  times  it  seemed  as 
if  the  vehicle  would  certainly  upset;  several  times  the 
driver  had  to  descend  from  his  seat  in  order  to  find  the 
road.  Ten  o'clock  came,  but  no  station  or  any  sign 
of  one!  I  had  just  examined  my  watch  and  found  it 
II  o'clock,  when  on  making  a  short  curve  in  the  road, 
we  saw  a  smouldering  fire  but  a  short  distance  ahead. 
On  reaching  it,  we  found  that  it  was  a  small  camp  of 
two  waggons.  I  got  out  and  awoke  one  of  the  sleepers 
(there  were  two  of  them),  who  sat  up  in  his  bed,  but 


FRONTIER   LIFE  27 

was  not  very  communicative.  He  told  me  that  the 
station  was  about  two  miles  further,  but  added,  "  over 
the  worst  road  in  California."  I  thanked  him  for  this 
cheering  intelligence,  and  was  about  to  go  on,  when  he 
told  me  that  the  .last  mile  was  through  a  very  bad 
canon,  and  then  lying  down  and  pulling  the  bed-cloth- 
ing closely  around  him,  he  remarked  to  his  companion, 
"  He'll  have  a  devil  of  a  time  getting  through  that 
canon  to-night !  "  which  put  me  into  such  a  good  frame 
of  mind  that  I  gave  the  order,  at  once,  "  go  ahead." 
One  mile  and  we  had  reached  the  mouth  of  this 
canon,  and  as  we  proceeded,  step  by  step,  the  hills 
arose  on  either  side  high  and  dark.  If  before  it  had 
been  dark,  it  was  now  the  very  blackness  of  darkness. 
The  trees  overhead  cut  off  every  ray  of  light.  The 
mules  seemed  disinclined  to  venture  on,  even  under  the 
lash,  and  it  began  to  look  as  if  further  progress  was 
impossible.  I  got  out  to  take  a  look,  but  all  I  could 
find  out  was  that  we  were  in  the  midst  of  rocks  and 
deep  sand  and  no  sign  of  a  road!  What  was  to  be 
done?  Fortunately  the  driver  had  a  lantern  and  a  part 
of  a  candle.  This  we  lit,  and  taking  with  me  a  soldier 
who  was  riding  with  the  driver,  I  started  ahead  to 
show  the  way.  By  keeping  just  in  front  of  the  team 
and  holloaing  "  Now  to  the  right,"  "  Now  to  the  left," 
and  "  Now  straight  ahead,"  we  managed  to  make  some 
progress.  Poor  E.  all  this  time  was  in  the  ambulance 
alone,  and  calling  out  continually,  "  Where  are  you,  Dr. 
Reed?  Please  come  back  and  let  the  soldier  carry  the 
lantern,"  but  I  told  her  I  could  trust  no  man  living  to 
point  the  way  out  of  this  horrible  canon;  and  on  I 
went  in  sand  nearly  up  to  my  knees,  calling  to  the 
driver  all  the  time  what  course  he  should  take.  Not- 


28      WALTER   REED   AND   YELLOW   FEVER 

withstanding  the  very  great  advantage  the  lantern  af- 
forded and  that  I  had  an  excellent  driver,  every  fifty 
yards  would  find  a  wheel  stopped  by  some  great 
boulder.  Oh !  the  terrible  difficulties  of  that  night !  But 
everything  must  have  an  ending,  and  after  we  had  been 
working  like  beavers  for  an  hour,  success  at  last  crowned 
our  efforts.  We  had  passed  the  canon  and  reached  the 
station!  (12.30  A.  M.)  Ah!  I  should  like  to  tell  you 
what  a  sigh  of  relief  escaped  my  breast  and  how  happy 
I  felt  when  I  saw  the  little  house  by  the  wayside.  *  . 
I  soon  aroused  the  station-keeper,  who  was  a  very 
rough-looking  specimen  of  a  frontiersman,  but  under 
all  this  roughness  he  concealed  a  kind  heart,  as  you 
will  see. 

But  let  me  describe  the  station,  called  "  Jamul " 
(pronounced  "Harmool").  It  consisted  of  a  small 
house  about  10  feet  square,  and  a  horse  stable.  The 
keeper's  residence  (the  same  house  above  mentioned) 
was  constructed  of  plain  boards,  with  spaces  of  half 
an  inch  between  the  boards,  possibly  for  ventilation, 
as  the  window  was  very  small.  A  dirt  roof  and  dirt 
floor.  A  piece  of  canvas  stretched  on  a  frame,  which 
he  called  his  "  bed,"  a  small  stool,  a  broken  chair,  a  pine 
table  and  a  cooking  stove  completed  the  furniture. 
Now  to  show  you  the  kind  heart  that  this  rough  fellow 
had,  he  no  sooner  found  that  I  had  my  wife  with  me 
than  he  not  only  made  a  roaring  fire,  prepared  us  both 
a  nice  cup  of  hot  tea  (which  with  the  lunch  that  we 
had,  enabled  us  to  make  a  good  meal),  but  he  also 
abandoned  his  "  bed  "  for  us,  himself  sleeping  for  the 
rest  of  the  night  in  the  stable!  and  for  this  kindness 
he  not  only  did  not  charge  a  penny,  but  he  would  not 
take  a  cent  although  I  insisted  upon  paying  him!  As 


FRONTIER   LIFE  29 

soon  as  Emllie  got  within  doors  and  saw  the  bright 
fire,  her  spirits  rose  accordingly,  and  when  the  tea 
was  ready  and  we  each  had  our  cup,  her  humour  was 
of  the  best.  All  her  sprightliness  returned  and  as  she 
took  a  glance  around  the  room  and  saw  the  various 
articles,  she  laughed  heartily,  and  declared  that  she 
wouldn't  take  anything  for  this  experience.  We  talked 
of  homefolks  and  wished  that  they  could  see  us  just 
as  we  were.  The  "  bed  "  was  especially  an  object  of 
much  merriment  to  Emilie.  She  declared  that  she 
could  never  rest  on  such  a  contrivance;  but  when  I  had 
arranged  things  a  little,  had  spread  over  the  piece  of 
canvas  a  blanket  which  I  found  in  the  room  and  had 
drawn  my  overcoats  over  us,  we  both  soon  fell  asleep 
and  did  not  wake  till  broad  daylight.  Thus  passed 
Emilie's  first  day  and  night  on  her  trip  to  Camp 
Lowell!  .  .  . 

Fortunately  both  Dr.  Reed  and  his  wife  pos- 
sessed a  keen  sense  of  humour,  which  helped  them 
over  many  of  their  hardest  experiences.  The  fol- 
lowing anecdote  told  me  by  Mrs.  Reed  shows  how 
valuable  a  sense  of  the  ludicrous  was  among  such 
surroundings. 

Late  one  evening  they  drove  up  to  a  little  shanty 
perched  on  the  side  of  the  mountain,  where  the 
country  was  so  barren  that  there  was  not  earth 
enough  to  drive  their  tent  pegs,  and  they  were 
forced  to  seek  shelter  for  the  night  in  the  hut.  Dr. 
Reed  had  stopped  at  this  place  on  his  way  to  San 
Francisco,  and  when  he  alighted  he  expected  to  find 


30      WALTER   REED   AND   YELLOW   FEVER 

the  same  friendly  owner  with  whom  he  had  made 
acquaintance  three  weeks  before.  To  his  surprise 
an  entire  stranger  appeared,  who  told  him  that 
when  roaming  over  the  prairie  a  week  or  two  be- 
fore, he  had  come  across  this  hut  uninhabited, 
while  the  body  of  the  former  owner  lay  outside 
with  a  bullet  through  his  heart.  When  Dr.  Reed 
asked  whether  they  could  have  accommodation 
for  the  night,  the  man  replied  in  the  affirmative, 
but  said,  referring  to  the  previous  owner,  "  The 
kyotes  [coyotes]  have  about  finished  him,  and  I 
hope  the  young  lady  will  not  be  afeared  of  his 
arm  bone.  I  use  it  to  prop  open  the  window." 
And  there,  sure  enough,  was  the  bone  in  the  win- 
dow just  over  the  spot  where  the  visitors  were  ex- 
pected to  sleep  I 

Thirty  years  ago  Arizona  seemed  as  remote 
from  civilisation  as  the  Philippines  do  now.  Com- 
munication with  the  East  was  imperfect  and  ir- 
regular; at  one  time  when  Dr.  Reed  was  stationed 
at  Camp  Apache,  he  was  seven  hundred  miles 
from  a  railroad,  the  mail  arrived,  only  once  a  week, 
and  letters  from  the  East  were  often  six  weeks  on 
the  way.  Life  at  these  distant  posts  was  always 
hard  and  often  desolate,  nor  was  the  element  of 
danger  absent.  Dr.  Reed,  it  is  true,  was  never  in 
the  field,  but  the  unsettled  condition  of  the  coun- 
try and  the  presence  of  hostile  Indians  were  a 


WALTER    REED    IN    1876 
From  a  photograph  taken  in  Harrisonhurg,  Va.      JEtat  25 


FRONTIER  LIFE  31 

constant  source  of  peril.  On  one  occasion,  when 
moving  from  Camp  Lowell  to  Camp  Apache,  a 
journey  of  eleven  days,  Reed  and  his  wife,  with  an 
escort  of  two  soldiers,  camped  for  the  night  on  a 
quiet  plain,  which  three  days  later  was  the  battle- 
ground between  two  hostile  tribes,  who  engaged 
in  a  bloody  fight  and  left  the  peaceful  spot  a  scene 
of  frightful  carnage.  At  another  time  when  Dr. 
Reed  had  been  relieved  and  was  hastening  to  join 
his  wife  and  child,  a  brother  officer  urged  him  to 
break  the  journey  by  stopping  at  his  post,  which 
was  on  the  stage  route,  and  Dr.  Reed  would  have 
complied  had  it  not  been  for  his  strong  desire  to 
join  his  wife  without  delay.  He  often  said  that 
his  eagerness  to  push  forward  saved  him  from  im- 
minent peril  and  perhaps  death,  for  the  stage  on 
which  he  would  have  travelled  had  he  been  a  day 
later,  as  suggested,  was  waylaid  by  the  Navajoes 
and  the  driver  killed. 

In  the  summer  of  1877,  after  a  year  spent  at 
Fort  Lowell,  Dr.  Reed  was  transferred  to  Fort 
Apache,  a  journey  which  he  and  Mrs.  Reed  again 
performed  in  true  frontier  fashion.  He  himself 
gives  a  most  graphic  description  of  the  difficulties 
which  they  encountered  to  his  sister-in-law,  Mrs. 
Harrell,  and  the  account  is  so  full  of  interest  and 
of  colour  that  I  give  the  letter  almost  in  full : 


32      WALTER   REED   AND   YELLOW   FEVER 

CAMP  APACHE,  ARIZONA, 

October  25,  1877. 

In  this  territory,  as,  in  fact,  in  all  others,  officers 
of  the  army,  especially  those  who  are  married,  travel 
by  ambulance  whenever  they  can  get  one.  Now  I 
know  the  word  ambulance  will  at  once  recall  to  your 
mind  a  long,  black,  funereal-looking  vehicle,  such  as 
you  probably  saw  during  the  war.  These  army  ambu- 
lances, however,  are  constructed  on  the  same  pattern 
as  the  ordinary  stage,  only  a  little  smaller,  have  two 
seats  capable  of  seating  four,  and  are  drawn  by  four 
to  six  mules.  They  are  painted  white  so  as  to  absorb 
the  terrible  heat  of  the  climate  as  little  as  pos- 
sible. Such  a  vehicle  you  would  have  seen  standing  in 
front  of  our  quarters  at  Camp  Lowell  at  nine  o'clock 
on  the  morning  of  August  nth  last.  The  waggon 
containing  our  baggage,  to  the  extent  of  1700  Ibs., 
had  started  for  Apache  on  the  morning  of  the  loth, 
so  that  we  had  but  few  things  to  put  in  the  ambulance. 
I  will  enumerate  its  contents  as  it  stood  ready  for  the 
word  to  be  given,  "  go  ahead."  Inside  of  the  vehicle 
there  were  the  following  articles:  On  the  back  seat, 
Emilie,  the  dog  Undina,  and  myself;  under  the  back 
seat,  a  box  of  medicines  for  emergencies,  a  lunch 
basket,  a  jar  of  preserved  ginger,  a  pair  of  boots,  a 
blacking  brush,  a  bag  containing  a  saucepan,  frying 
pan,  tin  pan,  and  coffee  pot.  On  the  front  seat,  two 
folding  chairs,  my  valise,  Emilie's  companion,  a  basket 
containing  her  work,  a  bundle  of  shawls,  my  overcoat, 
two  double  blankets,  a  feather  pillow,  a  clothes  brush, 
and  four  books  of  light  literature ;  under  the  front  seat, 
a  mess-chest  containing  the  necessary  tableware  for  the 
journey,  a  box  of  provisions,  and  a  large  clothes  basket 


FRONTIER   LIFE  33 

containing  everything  from  a  hairpin  to  a  pair  of 
shoes.  Suspended  from  various  points  of  the  roof 
were  two  hats,  a  sword,  an  umbrella,  a  pair  of  E.'s 
shoes,  a  carbine,  a  pistol,  a  belt  full  of  cartridges,  and 
two  canteens  filled  with  water.  Now  for  the  outside: 
underneath  the  driver's  seat  in  front  were  my  private 
case  of  instruments  weighing  50  Ibs.,  a  sack  of  grain, 
and  the  driver's  rations  for  ten  days;  on  the  seat  be- 
hind, my  trunk,  and  bedding  consisting  of  a  mattress, 
blankets,  sheets,  etc.,  done  up  in  a  canvas  cover. 
There  may  have  escaped  my  memory  a  few  articles, 
but  I  believe  I  have  mentioned  all.  If  there  was  any- 
thing on  top  I  did  not  see  it.  I  have  a  lurking  idea, 
however,  that  the  driver  concealed  several  chairs  and 
boxes  in  odd  places  about  the  vehicle.  I  forgot  to  say 
that  beside  the  driver  there  was  a  corporal  on  the  seat 
with  him,  a  very  light  man,  weighing  just  two  hun- 
dred Ibs. 

Thus  equipped,  after  bidding  good-bye  to  our 
Lowell  friends,  we  started  for  Camp  Apache,  external 
temperature  110°.  As  Undina  had  never  before  rid- 
den in  a  vehicle,  she  straightway  set  up  a  terrific  bark- 
ing, which  she  kept  up  till  she  was  so  hoarse  that  she 
couldn't  hear  herself,  and  then  stopped.  Our  destina- 
tion for  the  first  day  was  "  Tres  Alimos "  or  "  The 
Three  Cottonwoods,"  a  small  settlement  40  miles 
from  Lowell.  Aside  from  the  heat,  the  day  was  not 
an  unpleasant  one  for  travelling.  We  passed  our  time 
in  chatting  and  laughing  at  Undina's  queer  freaks  (who, 
by  the  way,  wasn't  quiet  in  any  one  place  for  a  minute 
at  a  time)  till  it  was  time  for  taking  lunch.  Perhaps 
you  have  never  taken  what  is  called  a  "  flying  lunch." 
If  not,  let  me  tell  you,  you  have  missed  a  great  deal 


34      WALTER   REED   AND   YELLOW   FEVER 

of  fun.  Mind  you,  everything  connected  with  the  meal 
is  done  while  the  ambulance  is  in  full  progress — no 
stopping  "  five  minutes  for  refreshments,"  and  as  the 
road  is  most  often  very  rough  and  rocky,  and  always 
so  when  you  think  it  is  about  time  to  eat,  and  as  the 
driver  concludes  to  whip  his  horses  up  to  their  very 
best  speed  just  at  this  time,  whereas  he  had  been  per- 
sistently permitting  them  to  walk  for  the  last  hour, 
why,  the  feat  of  getting  anything  into  your  mouth  be- 
comes a  matter  of  considerable  uncertainty. 
It  is  needless  for  me  to  narrate  at  length  all  the  trials 
of  this  meal;  I  could  not,  however,  forbear  showing 
you  what  you  have  missed  by  never  partaking  of  a 
"  flying  lunch." 

At  sunset  we  reached  our  destination,  '  Tres 
Alimos"  When  I  had  got  Emilie  into  a  very  comfort- 
able and  well-furnished  room,  I  proceeded  to  unpack 
all  those  articles  enumerated  in  the  beginning  of  my  let- 
ter, and  when  you  take  into  consideration  the  fact  that 
I  had  to  unpack  all  of  them  every  night  and  put  them 
back  every  morning,  you  will  know  that  it  was  quite 
a  task.  I  would  have  had  one  of  the  men  do  the  pack- 
ing for  me,  but  it  would  have  taken  so  long  to  teach 
him,  for  every  article  had  to  go  in  a  certain  place  and 
nowhere  else,  that  I  thought  it  would  be  easier  to  do  it 
myself.  At  7  o'clock  we  had  a  very  nice  supper,  con- 
sisting of  fried  spring  chicken,  good  milk,  butter,  etc., 
and  after  I  had  seen  about  a  lunch  for  the  morrow,  we 
retired,  for  we  were  to  start  the  next  morning  at  4 
o'clock,  so  as  to  reach  the  next  station,  30  miles  distant, 
before  noon  and  thus  avoid  the  heat  of  the  after- 
noon. .  .  . 

At  the  aforesaid  hour  we  were  up  and  preparing 


FRONTIER   LIFE  35 

for  our  journey.  A  cup  of  tea  and  everything  stowed 
away  safely  in  the  ambulance,  not  forgetting  the  little 
dog,  and  we  were  ready  for  our  day's  trip.  This  day 
we  had  to  pass  what  are  called  the  "  Lime  Kilns,"  a 
place  where  Indians  (I  mean  hostile  ones)  have  been 
often  seen,  and  I  must  confess  that  I  felt  the  least  bit 
anxious.  However,  I  said  nothing  to  E.  about  it,  but 
took  good  care  to  have  all  my  weapons  loaded  and 
in  good  reach  and  kept  my  eyes  well  open.  When  I 
imagined  that  we  were  pretty  near  the  "  Kilns "  I 
called  to  the  driver  and  told  him  to  let  me  know  when 
he  got  there,  whereupon,  much  to  my  satisfaction,  he 
replied  that  we  had  already  passed  them.  A  ride  of 
15  miles  further  and  we  had  reached  our  station,  called 
'  The  Point  of  the  Mountain  " ;  so  named  from  the 
fact  of  the  station  being  situated  just  where  a  mountain 
range  abruptly  ends  on  the  plain.  Looking  across  a 
plain,  20  miles  in  width,  we  can  see  the  "  Chiricahua 
Mountains,"  well  known  in  Arizona  history  as  the 
home  of  the  celebrated  Indian  Chief  "  Cochise  "  and 
his  Chiricahua  tribe,  Indians  that  have  killed  more 
people  in  Arizona  than  all  the  other  tribes  put  to- 
gether. We  can  follow  with  the  eye  the  plain,  white 
stage  road  as  it  stretches  across  the  intervening  coun- 
try and  see  it  where  it  enters  the  mountains.  Could 
the  eye  but  follow  it  4  miles  further,  we  should  see 
the  spot  where  three  mail-riders  have  recently  fallen, 
pierced  by  the  bullets  of  the  savages.  The  last  one  was 
killed  just  a  week  before  we  commenced  our  journey. 
This  night,  as  we  had  very  good  accommodations, 
we  rested  very  well  and  awoke  much  refreshed.  You 
would  think  it  rather  fatiguing,  I  guess,  to  have  to 
ride  go  miles  in  two  days.  But  there's  nothing  like 


36      WALTER   REED   AND   YELLOW   FEVER 

getting  used  to  a  thing,  so  that  even  frail  little  Emilie 
Lawrence  Reed,  although  she  had  ridden  and  jolted 
over  70  miles  of  rough  road  in  two  days,  stepped  out 
of  the  station  on  the  third  morning  as  bright  as  a  silver 
dollar  and  ready  to  ride  50  miles  before  sunset,  if 
necessary.  However,  it  was  only  35  miles  we  had  to 
go  on  the  third  day.  Our  journey  lay  along  a  very 
pretty  green  valley,  bordered  on  either  side  with  a 
range  of  blue  mountains.  The  road  was  level  and  as 
smooth  as  could  be  desired.  On  our  right  across  the 
valley,  distant  about  10  miles,  we  could  distinguish 
11  Camp  Grant,"  a  military  post  in  this  Territory.  We 
had  first  thought  of  going  by  way  of  Grant,  so  as  to 
rest  a  day  or  two,  but  concluded  to  abandon  the  idea, 
as  we  would  really  have  to  receive  and  return  so  many 
calls  that  our  rest  would  be  of  little  use  to  us.  This 
day's  ride  was  especially  pleasant,  as  we  saw  plenty 
of  green  grass  and  liveoak  trees,  objects,  especially  the 
latter,  that  we  had  not  seen  for  many  a  day.  We 
passed  through  numerous  herds  of  cattle,  and  saw 
many  others  scattered  here  and  there  over  the  valley, 
which  added  much  to  the  beauty  of  the  landscape. 
Toward  afternoon  the  land  became  beautifully  rolling 
and  at  2  p.  M.  we  alighted  at  "  Eureka  Springs,"  the 
best  station  in  Arizona. 

Here  we  found  a  large  house,  having  4  or  6 
rooms  and  the  windows  provided  with  real  window- 
blinds,  and  green  ones  too.  A  servant  took  our  bag- 
gage and  we  were  ushered  into  as  nicely  furnished  a 
room  as  one  could  ask  for.  A  good  carpet,  bedstead, 
bureau,  centre  table,  etc.,  etc.  By  the  time  we  had 
freed  ourselves  of  the  dust  of  travel,  we  were  sum- 
moned to  a  nice  dinner  of  fat  mutton,  vegetables,  but- 


FRONTIER   LIFE  37 

termllk,  and  all  manner  of  good  things.  My!  how  we 
made  the  eatables  fly!  and  such  nice,  cold,  well  water. 
Ah!  this  was  a  luxury  which  we  could  scarcely  drink 
enough  of.  In  a  word,  so  charmed  were  we  both  with 
this  station  that  we  concluded,  at  once,  to  remain  over 
a  day,  and  '•est  and  eat!  We  arrived  on  Monday  and 
left  on  Wednesday.  On  the  latter  day  we  travelled  30 
miles  to  reach  Camp  Thomas,  a  military  post.  We 
stopped  at  Lieutenant  Powell's  house,  a  bachelor  ac- 
quaintance of  mine.  In  fact  there  was  only  one  married 
officer  at  the  post  and  his  wife  was  East.  Emilie  was 
the  first  lady  ever  at  the  post.  She  was  such  a  curiosity 
that  one  little  dog  chancing  to  spy  her,  took  to  his  heels 
for  dear  life,  yelling  at  every  jump.  He  soon  returned 
reinforced  by  about  20  others  and  such  a  barking  you 
never  heard.  None  of  them,  though,  had  the  courage 
to  advance  very  close.  At  Thomas  we  were  enter- 
tained just  as  hospitably  as  possible,  as  army  officers 
always  are  when  passing  through  a  garrison.  We  re- 
mained over  here  a  day  also,  in  order  to  allow  my 
waggon  to  precede  me  one  day. 

We  left  Camp  Thomas  on  Friday  and  came  33 
miles,  part  of  the  day  over  very  rough  roads.  We 
passed  through  large  orchards  of  "  prickly  pears,"  a 
fruit  which  grows  on  the  large-leaved  cactus.  The 
fruit  is  the  size  of  a  large  pear,  of  a  beautiful  purple 
colour,  and  an  acid,  agreeable  taste.  Emilie  insisted 
upon  eating  several,  whereof  she  much  repented  before 
next  morning.  Our  destination  for  the  day  was 
"  Green's  Camp,"  so  called  from  the  fact  that  Lieu- 
tenant Green,  of  the  army,  camped  there  many  years 
ago.  For  the  first  time  on  our  journey  we  had  to  camp 
put  under  the  open  heavens,  as  there  is  not  a  house  be- 


38     WALTER   REED   AND   YELLOW   FEVER 

tween  Camp  Thomas  and  Camp  Apache.  We  arrived 
in  camp  about  3  P.  M.  Soon  afterwards  I  saw  an  Indian 
on  a  hill  opposite  camp.  He  came  over,  sat  down  by 
the  side  of  me,  and  laying  down  his  gun,  said  "El 
campo  Apache,"  by  which  I  knew  that  he  was  going  to 
Apache.  A  minute  later  he  said  "pan"  at  which  I 
wasn't  surprised,  for  they  are  always  ready  to  eat.  I 
gave  him  a  loaf  that  was  as  dry  as  ashes  and  as  hard 
as  a  "  nigger's  head,"  and  the  way  he  demolished  it  was 
astonishing.  Having  filled  his  stomach,  he  picked  up 
his  gun,  said  "  adios"  and  a  moment  later  was  lost  to 
v  sight.  When  I  got  to  Apache  our  recognition  was 
mutual.  The  Indian  turned  out  to  be  the  celebrated 
"  Dead-shot,"  so  named  because  he  never  misses  his 
game,  whether  man  or  otherwise.  We  had  our  supper 
under  the  "  umbrageous  foliage  "  of  a  cedar  tree  and 
about  6.30  P.  M.  prepared  to  retire.  We  had  no  tent, 
but  slept  in  the  ambulance.  The  seats  were  so  con- 
structed that  they  could  be  slid  together,  forming  a 
perfect  floor.  On  this  came  our  bedding  and  when  we 
had  made  the  curtains  fast  and  tight,  we  were  ready 
for  hail  or  rain.  Little  Undina  each  night  found  a 
warm  bed  at  our  feet. 

We  broke  camp  Saturday  morning  about  8  o'clock, 
as  we  only  had  12  miles  to  go  in  order  to  reach  water, 
for  you  must  remember  that  in  Arizona  the  length  of 
a  day's  travel  depends  upon  the  distance  between 
watering  places.  There  are  no  streams  every  few  miles, 
as  in  the  East.  Sometimes  you  go  forty  or  even  sixty 
miles  without  seeing  a  drop  of  water,  and  you  rarely 
have  to  travel  less  than  30  miles.  "  Ash  Creek,"  our 
camp  this  day,  was  reached  by  noon.  I  made  a  heroic 
effort  to  catch  some  fish  here,  but  after  broiling  in  the 


FRONTIER   LIFE  39 

sun  an  hour  I  only  got  one  bite  and  that  proved  to  be  a 
plaguey  turtle,  to  get  which  off  my  hook  consumed 
another  hour.  I  gave  up  fishing  in  disgust.  "  Ash 
Creek  "  is  worth  mentioning  'for  this  reason :  about  the 
time  our  dinner  was  well  under  way  a  terrific  rain- 
storm came  up,  and  as  our  bake-oven  had  no  top  our 
bread  was  soon  afloat  and  the  poor  soldier,  our  cook, 
looked  as  if  he  had  lost  his  best  friend;  but  it  was 
no  use  to  try  to  make  anything  out  of  that  bread,  for 
it  was  so  soaked  that  it  weighed  a  pound  to  the  square 
inch. 

We  left  our  camp  next  morning  bright  and  early, 
as  we  were  this  day  to  pass  over  the  worst  road  in 
Arizona,  yes,  the  worst  road  in  the  world.  When  we 
had  gone  about  4  miles  we  began  to  ascend  very  slowly 
and  gradually  the  slope  of  the  "  White  Mountains." 
Soon  we  entered  what  is  called  "  Rocky  Canon  "  and 
no  person  who  has  been  over  this  "  Canon  "  once  will 
ever  forget  it.  It  is  useless  for  me  to  attempt  to  de- 
scribe this  road  to  you.  It  is  simply  beyond  language  to 
describe  its  awful  roughness.  For  a  distance  of  about 
3  miles  the  ambulance  scarcely  touches  "  terra  firma  " ; 
the  wheels  jump  from  rock  to  rock  with  a  perfect 
crash  at  times.  But  this  is  the  good  part  of  the  road, 
I  assure  you.  When  we  had  gone  over  this,  which  re- 
quired about  2  hours,  we  came  to  what  is  designated 
"  Nautaumes  Hill."  This  is  about  three-quarters  of  a 
mile  long  to  the  summit.  Standing  at  the  foot  of  the 
hill  and  casting  your  eye  upwards,  you  see  nothing  but 
solid  stone,  broken  and  tossed  into  all  manner  of 
shapes  and  positions.  You  would  declare  that  no  such 
thing  as  a  waggon  could  ever  go  up  or  come  down  with- 
out being  smashed  into  a  thousand  fragments.  Im- 


40     WALTER   REED   AND   YELLOW   FEVER 

agine  the  steepest  hill  you  ever  saw,  and  then  imagine 
its  surface  covered  with  stones  the  size  of  flour  barrels, 
packed  just  as  closely  as  possible,  some  on  end,  some 
on  their  sides,  and  some  on  their  edges,  and  then  you 
have  not  formed  a  conception  of  this  hill. 

The  first  thing  to  be  done  was  to  make  every- 
thing perfectly  snug  inside  the  ambulance,  and  then 
to  fasten  two  strong  ropes,  one  to  each  side  of 
the  vehicle.  To  each  rope  two  strong  men  held  and 
then  the  ambulance  was  ready  to  start.  The  idea  of 
the  ropes  was  to  keep  it  from  upsetting,  as  very  fre- 
quently only  two  wheels  are  on  the  ground,  or  stones, 
I  should  say.  After  the  mules  have  plunged  as  if  they 
would  break  their  necks,  we  get  a  start,  every  man 
holding  on  to  the  ropes  for  dear  life,  the  vehicle  rising 
and  falling,  swaying  and  creaking,  as  if  it  would  cer- 
tainly go  to  pieces  the  next  jump;  fifty  feet  and  we 
stop  for  breath;  and  it  is  a  repetition  of  this  from  the 
foot  to  the  top  of  the  hill.  It  took  just  one  hour  and  a 
half  for  my  ambulance  to  make  the  three-quarters  of  a 
mile.  As  for  my  waggon,  although  I  had  only  1700 
pounds  in  it,  yet  the  twelve  mules  that  I  had  harnessed 
to  it,  with  the  help  of  my  four  ambulance  mules,  could 
not  budge  it  when  it  reached  the  foot  of  this  hill.  I 
worked  from  10  A.  M.  till  5  P.  M.  and  at  that  time  we 
had  made  just  thirty  feet  by  actual  measurement!  I 
saw  that  it  was  useless  to  worry  my  animals  any  longer, 
so  that  I  ordered  the  men  to  unhitch  and  camp  there 
for  the  night.  As  for  myself,  I  came  on  about  three 
miles  further  to  "  Camp  Disappointment "  and  spent 
the  night  under  the  lofty  pines.  I  had  with  me  only 
the  corporal  and  driver.  Emilie  was  very  much  afraid 
of  bears  and  Indians  until  we  got  a  rousing  fire  started, 


41 

and  then  her  spirits  rose  and  she  ate  quite  a  hearty  sup- 
per, which  I  cooked,  as  we  had  left  our  cook  back  with 
the  waggon.  I  had  left  orders  to  unpack  the  waggon  and 
carry  part  of  the  load  up  the  hill  on  the  mules.  This 
they  did,  and  thus  managed  to  get  up  next  day  and 
reach  u  Camp  Disappointment." 

I  will  describe  briefly  one  more  hill  and  then  I  am 
done  with  my  letter.  On  this,  the  last  day  but  one, 
we  travel  down  "  Black  River  "  hill,  the  steepest  hill  I 
ever  saw ;  so  steep  that  it  is  necessary  to  lock  the  wheels 
and  to  drag  behind  the  ambulance  a  large  tree.  Be- 
sides this,  we  fasten  two  ropes  to  the  rear  of  the 
vehicle,  to  one  of  which  the  corporal  swings  and  to  the 
other  my  cook  (who  has  overtaken  us)  and  myself. 
The  driver  descends  from  his  seat,  for  the  danger  is 
that  the  ambulance  will  go  end  over  end.  Having 
taken  out  the  lead  mules,  we  commence  our  downward 
progress  slowly.  We  descend  about  sixty  feet  and  then 
come  to  the  "  jumping-off  "  place,  for  it  is  a  sheer 
descent  of  five  feet,  right  over  the  face  of  a  rock. 
Here  we  stop,  examine  every  rope,  every  man  braces 
himself  for  the  struggle  and  the  question  is  asked, 
"  Are  you  ready?  "  The  answer  is  "  All  ready,  sir,"  and 
the  words  given,  "  Let  her  go!  "  We  pause  a  moment 
and  then  are  jerked  full  twenty  feet  right  over  the 
rocks !  So  sudden  was  the  leap  and  with  such  terrible 
force  did  I  strike  the  ground  that  the  very  soles  of  my 
shoes  were  torn  off !  Suffice  it  to  say  that  my  ambu- 
lance landed  safely  and  unbroken,  and  as  the  rest  of 
our  journey  was  smooth  sailing,  I  will  not  inflict  an 
account  of  the  next  day's  trip  upon  you.  Forgive  me, 
for  I  never  wrote  so  disconnected  a  letter  before  in  my 
life.  If  you  will  only  promise  to  burn  It  as  soon  as  read, 


42      WALTER   REED   AND   YELLOW   FEVER 

all  right;  it  is  on  this  sole  condition  that  I  send  it. 
Emilie  joins  me  in  love  to  all.  Pardon  my  abrupt 
ending,  write  soon,  and  believe  me  very  affectionately, 
your  brother,  WALTER  REED. 

Camp  Apache  was  at  length  reached  in  safety, 
and  there  the  Reeds  remained  nearly  four  years, 
during  which  time  their  eldest  child,  Walter 
Lawrence  Reed,  was  born,  on  December  4,  1878. 
Their  life  during  these  years  was  not  lacking  in 
the  difficulties  and  privations  with  which  existence 
on  the  frontier  is  always  filled,  but  these  were  met 
by  them  in  the  brave  and  cheerful  spirit  which  re- 
duces all  troubles  to  a  minimum.  The  following 
letter  from  Dr.  Reed  to  Mrs.  Harrell  gives  an 
amusing  account  of  one  variety  of  annoyance  with 
which  he  and  his  wife  had  to  contend. 

CAMP  APACHE,  ARIZONA, 

April  14,  1878. 

You  know  that  in  civilised  life  it  is  not  allowable 
for  an  officer  to  have  a  soldier  do  his  cooking,  because 
he  can  easily  get  servants  to  do  his  work.  But  on  the 
frontier,  and  especially  in  such  a  delectable  country  as 
"  Arizony  "  where  it  is  simply  impossible  to  find  hand- 
maidens, unless  it  be  an  occasional  Chinaman,  it  is  per- 
mitted to  use  soldiers  as  cooks,  provided  they  are  will- 
ing to  cook.  Of  course  it  is  at  the  option  of  the  soldier 
whether  he  will  do  duty  with  his  company  or  cook.  I 
will  premise  by  saying  that  nearly  all  soldiers  can  cook 
after  a  fashion,  and  some  of  them  very  well,  but  most 


FRONTIER   LIFE  43 

of  them  have  a  dislike  to  cooking  for  a  married  officer. 
The  "  pig  under  the  fence  "  is  the  officer's  wife.  Sol- 
diers will  take  any  order  and  any  amount  of  abuse  from 
an  officer  without  murmuring,  but  when  it  comes  to  re- 
ceiving orders  or  even  suggestions  from  a  lady,  they 
rebel  at  once.  .  .  .  Another  point  to  bear  in  mind 
is  that  soldiers,  with  but  few  exceptions,  are  very  fond 
of  their  "  toddy  "  and  always  get  drunk  after  pay  day, 
which  comes  every  two  months. 

You  will  remember  that  up  to  December  last  we 
messed  with  Mrs.  Colonel  Andrews,  and  hence  had  no 
trouble  about  cooks.  On  the  first  of  December,  how- 
ever, we  went  to  housekeeping,  for  reasons  which  it  is 
not  necessary  to  state,  being  no  less  than  the  expected 
advent  of  a  "  kid,"  and  so  I  had  to  look  about  for  a 
soldier  to  do  my  cooking.  After  much  search  I  lit  upon 
one  James  Anmach,  a  high  private  in  the  rear  rank. 
Now  this  same  private  Anmach  is  a  considerable  per- 
sonage, having  had  no  less  than  seven  trades  or  pro- 
fessions, as  follows:  He  is  a  natural  born  plasterer; 
in  his  early  years  he  took  up  painting  as  a  fine  art;  wax- 
ing stronger  he  devoted  himself,  his  time  and  muscle 
to  carpentering;  finding  that  this  occupation  cramped 
his  mental  powers  too  much  he  turned  his  attention  to 
brightening  rusty  knife  blades  and  sharpening  scissors, 
etc. ;  subsequently,  circumstances  over  which  he  had  no 
control  forced  him  to  become  a  plumber,  for  you  know 
the  greatest  intellects  must  at  times  yield  to  the  course 
of  events;  and  finally,  ruthless  fortune  converted  him 
into  a  farmer.  Now  what  he  does  not  know  about 
horses  and  cows  is  entirely  superfluous  knowledge.  As 
an  extractor  of  the  "  albine  fluid  "  he  has  no  equal.  In- 
deed the  cow  herself  is  amazed  at  his  dexterous  per- 


44      WALTER   REED   AND   YELLOW   FEVER 

formance.  If  the  animal  manifests  any  desire  to  run 
him  through  with  her  horns,  he  throws  a  lariat  round 
the  horns  and  fastens  her  head  to  a  post;  and  then,  if 
she  makes  too  free  with  her  posterior  extremities,  he 
simply  ties  them  snugly  together  with  a  rope,  and  as 
he  milks  pays  not  the  least  attention  to  her  frantic 
efforts  to  extricate  herself. 

Such  an  one  was  James  Anmach,  my  new  cook,  on 
the  first  day  of  December,  1877.  I  should  state  that  he 
knew  nothing  about  cooking  whatever,  but  as  he  ex- 
pressed it  "  he  would  not  mind  learning  to  cook,  as  it 
might  be  useful  to  him  one  of  these  days."  I  presume 
the  real  reason  was  because  he  had  so  few  trades.  Upon 
his  assumption  of  the  culinary  dignity  I  had  a  brief 
interview  with  Mr.  Anmach,  in  which  I  expressed  to 
him  my  earnest  desire  that  he  would  abstain  from  all 
intoxicating  liquors,  for  a  time  at  least.  After  the  birth 
of  the  future  President  I  again  told  him  that  I  hoped 
while  Mrs.  Reed  was  sick  he  would  keep  sober,  for 
should  he  get  on  a  spree  and  absent  himself  for  a  week 
or  so,  I  would  have  no  one  to  cook  but  myself  and 
would  be  placed  in  a  most  deplorable  position.  He  de- 
clared that  should  he  think  of  getting  drunk  under  the 
circumstances  he  would  consider  himself  no  better  than 
a  "  dog  "  and  that  I  might  place  full  confidence  in 
his  sobriety. 

Fortunately  he  turned  out  to  be  a  very  fair  cook;  a 
plain  one,  but  he  knew  how  to  season  food  and  could 
make  pretty  good  bread  and  coffee,  beside  flannel  cakes, 
etc.  But  he  had  the  most  curious  ideas  about  crockery 
and  its  uses  of  any  man  I  ever  met.  In  the  first  place, 
he  had  a  perfect  mania  for  soup-plates.  It  made  no 
difference  what  the  dish  was,  whether  beefsteak, 


FRONTIER   LIFE  45 

chicken,  tomatoes,  corn,  flannel  cakes,  or  what  not,  he 
always  brought  it  to  table  in  a  soup-plate  and  insisted 
on  my  eating  out  of  the  same  kind  of  plate.  I  really 
believe  he  would  have  served  the  coffee  in  the  same, 
if  he  could  have  found  another  one.  Luckily  we  have 
only  six  soup-plates,  and  when  he  got  these  full  he  had 
to  resort  to  something  else.  I  gently  remonstrated  with 
him  and  pointed  out  the  uses  of  a  few  utensils,  but 
whether  my  explanations  confused  him  or  were  too  stu- 
pendous to  grasp,  I  know  not;  I  do  know  that  the  fol- 
lowing day  at  dinner  he  fairly  knocked  the  breath  out 
of  me  by  serving  the  tomatoes  in  the  slop-bowl,  the 
potatoes  in  the  soup-tureen,  and  the  pickles  in  the  gravy- 
boat.  I  ate  my  dinner  in  silence,  and  from  that  day  I 
never  made  any  suggestions  to  Mr.  Anmach.  He  took 
a  great  deal  of  pains  in  preparing  his  dishes,  but  when 
once  cooked  his  mission  ended,  and  he  served  them  re- 
gardless of  all  traditions. 

I  cannot  remember  all  the  ingenious  freaks  of  this 
man  Anmach.  On  one  occasion  he  served  the  soup  in 
the  cream  pitcher,  on  another  day  on  lifting  the  lid  of 
the  soup-tureen  what  should  I  find  but  half-a-dozen 
peach  dumplings  reposing  therein.  I  think  he  intended 
this  as  a  surprise,  but  I  betrayed  no  astonishment  what- 
ever. He  could  not  have  told  from  my  face  but  that  I 
had  been  used  to  eating  peach  dumplings  out  of  soup- 
tureens  all  my  life.  A  few  days  after  that  when  I  at- 
tempted to  fill  my  glass  with  water  and  found  instead 
boiled  potatoes  in  the  pitcher,  I  may  have  betrayed 
some  momentary  surprise,  but  I  think  not.  You  may 
think  I  am  falsifying,  but  I  assure  you  that  I  am  giving 
stern  facts. 

When  I  had  lulled  myself  into  the  belief  that  private 


46      WALTER   REED   AND   YELLOW   FEVER 

Anmach  would  cling  to  his  early  training  and  keep 
sober,  it  came  to  pass  that  that  season  of  the  year  drew 
nigh  which  has  been  so  beautifully  described  by  Lord 
Macauley  in  the  words  "Apple  cider,  cinnamon  beer; 
Christmas  comes  but  once  a  year."  Perhaps  the  recol- 
lection of  other  days  came  back  to  him  and  led  him 
astray,  for  at  any  rate  Christmas  night  I  heard  a  noise 
in  Anmach's  room  about  1 1  o'clock  and  going  in  found 
him  quite  drunk  and  made  him  go  to  bed.  I  locked  the 
door  and  put  the  key  in  my  pocket,  but  to  my  surprise 
when  I  went  to  his  room  next  morning  about  7  o'clock, 
I  found  the  bird  had  flown.  I  then  went  into  the  kitchen 
and  found  everything  in  confusion.  As  I  stood  there 
and  cast  my  eye  over  the  various  frying-pans  and  tea- 
kettles, and  especially  the  cold,  ashy  face  of  the  old 
stove,  I  realised  for  the  first  time  the  true  beauty  of 
soldier  cooks. 

I  returned  and  told  the  mother  of  the  future  Presi- 
dent that  our  festive  cook  was  gone,  and  took  council 
with  her  as  to  how  the  dilemma  was  to  be  met.  After 
a  brief  session  of  five  minutes'  duration,  it  was  decided 
that  I  should  peel  off  my  jacket  and  approach  the 
pensive  frying-pan.  I  cannot  say  that  I  essayed  the  task 
with  songs  of  joy  upon  my  lips,  but  still  I  was  deter- 
mined that  no  one  should  cheat  me  out  of  my  breakfast 
that  morning.  The  bill  of  fare  was  as  follows:  Pan 
fresco,  manteca,  cafe  caliente  y  huevos  asados.  Now 
does  not  that  sound  like  a  city  hotel  ?  Reduced  to  plain 
English  it  is  not  quite  so  overpowering,  but  fresh  bread, 
butter,  hot  coffee,  and  boiled  eggs  are  at  all  times  re- 
freshing. For  three  days  and  nights  I  saw  nothing  of 
my  truant  cook,  and  during  this  time  I  got  up  various 
unspeakable  and  uneatable  dishes.  Emilie,  however, 


FRONTIER   LIFE  47 

lacked  for  nothing,  for  the  ladies  sent  her  meals  regu- 
larly. On  the  morning  of  the  fourth  day  a  soft  knock 
at  the  door  announced  the  return  of  the  wanderer.  I 
had  fully  made  up  my  mind  to  give  him  "  rats,"  but  he 
ate  such  a  quantity  of  humble  pie  that  I  could  say  noth- 
ing. He  acknowledged  his  meanness  in  leaving  me  un- 
der the  circumstances,  calling  himself  a  good-for-noth- 
ing "  dog  "  and  promising  never  to  deceive  me  again. 
Everything  now  went  on  lovely,  and  as  Emilie  was 
out  of  bed  by  January  15  and  able  to  direct  affairs  I 
had  high  hopes  that  we  had  passed  the  worst.  Contrary 
to  my  advice,  however,  Emilie  insisted  that  the  vege- 
tables should  go  into  the  vegetable  dishes,  the  soup 
into  the  tureen,  and  a  lot  of  other  nonsensical  ideas 
which  I  felt  convinced  our  man  Friday  would  never 
submit  to.  And  sure  enough,  just  four  days  thereafter, 
January  I9th,  the  man  of  many  trades  slid  off  again, 
this  time  on  a  drunk  as  before,  and  again  I  was  elected 
cook.  After  waiting  five  days  and  finding  that  cooking 
was  a  trifle  monotonous  I  employed  another  cook,  pri- 
vate George  Powers,  the  "  meek-eyed."  He  did  very 
well,  and  as  he  was  sober  and  learned  willingly  and 
quickly,  Emilie  was  on  the  fair  road  to  make  him  a  first- 
class  cook.  But  lo!  there  were  breakers  ahead!  The 
Commanding  Officer's  cook  got  on  a  rampage  and  was 
sent  back  to   his   company.  Hence  the   Commanding 
Officer  (as  private  Powers  belonged  to  his  company) 
found  himself  under  the  "  painful  necessity  "   (which, 
by  the  way,  was  all  painful  fiddlesticks)  of  taking  our 
cook  to  cook  for  his  family.  So  on  March  ist  we  had 
to  let  him  go  and  take  as  our  bread-maker  one  private 
Bertrand  Howard,  the  sullen,  and,  I  may  add,  the  lazy. 
He  had  the  reputation  of  being  an  excellent  cook,  and 


48     WALTER   REED  AND   YELLOW   FEVER 

thought  he  knew  everything.  He  could  make  excellent 
cakes  for  breakfast  and  pretty  good  pumpkin  pies,  but 
beyond  this  his  cooking  was  a  mess.  He  could  not 
bear  for  Emilie  to  give  him  any  suggestions,  and  as  for 
her  coming  into  the  kitchen  it  made  him  very  angry 
for  a  week.  He  thought  he  knew  so  much  that  he 
wouldn't  follow  any  receipt  and  in  fact  just  cooked  after 
his  own  style  and  liking.  As  we  had  had  so  much 
trouble  I  begged  Emilie  to  put  up  with  him,  although 
she  could  hardly  help  throwing  a  frying-pan  at  his 
head.  Mr.  Howard  was  much  inclined  to  laziness,  so 
that  when  we  began  to  move  to  our  new  house  and  he 
found  he  would  have  to  do  a  little  extra  work  in  clean- 
ing the  kitchen,  he  came  to  me  and  said  he  would  like 
to  go  back  to  his  company.  I  was  so  disgusted  with  the 
gentleman's  performance  that  I  paid  him  and  told  him 
to  report  at  once.  Thus  blooming  April  found  us  once 
more  minus  a  cook,  and  that  too  while  we  were  busy 
moving.  I  tried  various  soldiers,  but  could  get  no  one 
to  come.  In  fact  there  seemed  to  be  a  perfect  dearth 
of  cooks,  and  I  knew  not  what  to  do,  when  a  happy 
thought  occurred  to  us.  What  do  you  suppose  it  was? 
It  was  E.'s  suggestion.  To  take  back  to  our  hearts  our 
old  friend  the  plasterer,  alias  the  painter,  alias  the  car- 
penter, alias  the  cutler,  alias  the  tinner,  alias  the  farmer, 
alias  the  cook,  alias  James  Anmach  of  the  Horse 
Marines ! 

And  we  did!  We  have  the  most  beautiful  contract 
drawn  up  imaginable,  and  it  is  as  simple  as  it  is  beauti- 
ful. Private  Anmach  agrees  to  cook  and  do  general 
work,  such  as  milking,  etc.,  to  put  the  soup  into  its 
proper  tureen,  and  not  to  put  the  potatoes  in  the  water 
pitcher,  provided  he  is  permitted  to  have  a  week's  drunk 


FRONTIER   LIFE  49 

after  each  pay  day,  or  once  in  two  months.  Once  more 
the  God  of  day  has  chased  away  the  clouds  and  we  are 
happy.  I  am  glad  to  say  that  under  E.'s  skilful  general- 
ship he  is  doing  amazingly,  even  going  so  far  as  to  make 
a  citron  pudding  after  your  latest  receipt,  which  was 
mighty  good  and  gave  us  indigestion  like  all  the  world. 
And  this  is  all  I  know  about  cooks  in  general  and 
soldier  cooks  in  particular.  Best  love  to  all,  in  which 
E.  and  baby  join.  Write  soon. 

Your  affectionate  brother, 

WALTER  REED. 

P.  S. — I  am  constrained  to  add  a  few  lines  which  are 
so  appropriate  to  the  present  occasion  that  I  hope  you 
will  not  consider  me  verbose. 

"  We  may  live  without  poetry,  music,  or  art; 
We  may  live  without  conscience  and  live  without 

heart; 
We  may   live   without  friends   and  live  without 

books; 
But  civilised  man  cannot  live  without  cooks," 

As  a  post  surgeon  Dr.  Reed  was  greatly  and 
deservedly  beloved.  At  this  time,  as  Dr.  Walter 
D.  McCaw  says  in  his  "  Memoir  of  Walter  Reed," 
the  young  medical  officer  at  an  army  post  was  gen- 
erally the  only  physician  at  the  station,  and  was 
called  upon  by  the  settlers  for  miles  around.  With- 
out help  and  with  only  such  instruments  and 
medicines  as  could  be  hastily  stuffed  into  his  sad- 
dle bags,  he  would  be  summoned  to  attend  a 


50      WALTER   REED   AND   YELLOW   FEVER 

fractured  thigh,  a  child  choking  to  death  with 
diphtheria,  or,  most  trying  of  all,  a  difficult  child- 
birth. At  one  time  when  Dr.  Reed  himself  was 
ill  with  a  fever  and  cared  for  by  the  hospital 
steward,  he  insisted  on  responding  to  any  urgent 
call,  would  get  up,  ill  as  he  was,  sit  down  repeat- 
edly while  dressing  for  lack  of  strength,  and  finally 
start  out  with  the  snow  deep  on  the  ground  and 
the  thermometer  far  below  zero.  It  has  more  than 
once  happened  that  on  reaching  the  patient's  house 
he  would  have  to  lie  down  and  recover  himself 
before  he  could  go  upstairs.  The  more  humble 
the  patient,  the  greater  was  Dr.  Reed's  devotion, 
for  the  impression  made  upon  him  by  his  experi- 
ence among  the  poor  in  his  New  York  district  was 
never  effaced,  and  his  heart  always  went  out  to 
the  lowly  and  the  ignorant. 

His  devotion  was  especially  strong  to  children, 
and  often,  if  some  little  one's  life  was  in  danger 
from  ignorance  and  want  of  proper  care,  he  would 
plead  with  his  wife  to  let  it  be  brought  to  his 
home  in  order  that  his  injunctions  could  be  carried 
out,  a  plan  which  she  was  forced  to  oppose,  as 
their  home  life  would  have  been  destroyed  if  their 
house  had  been  turned  into  a  hospital.  On  one 
occasion  he  brought  into  the  camp  a  little  Indian 
girl  of  four  or  five,  so  horribly  burned  that  her 
people  had  left  her  to  die.  This  child  he  sue- 


FRONTIER   LIFE  51 

ceeded  in  saving,  and  then  brought  her  up  in  his 
own  family  as  nurse  to  his  children,  in  spite  of  a 
friendly  warning  from  that  keen  old  Indian 
fighter,  General  Crook.  When  this  child  was 
nearly  a  woman  the  savage  Apache  blood  asserted 
itself  and  she  ran  away,  after  giving  abundant 
evidence  (so  says  Major  Kean)  that  fifteen  years 
of  kindness,  gentleness,  and  refinement  had  not 
modified  the  cruel  and  deceitful  characteristics 
of  her  race. 

The  friendly  Indians  settled  near  the  post  often 
sent  for  Dr.  Reed  to  prescribe  for  them,  and  he  was 
as  painstaking  in  their  behalf  as  in  that  of  any 
other  patient,  although  he  was  well  aware  that 
the  Medicine  Man's  word  had  much  more  weight 
than  his  own,  and  that  as  soon  as  he  was  gone  the 
drum  and  rattle  of  the  latter  would  be  persistently 
beaten  at  the  patient's  bedside,  even  though  he 
might  have  given  a  narcotic.  The  Indians,  never- 
theless, were  much  attached  to  him,  and  often 
showed  their  regard  by  bringing  him  a  haunch 
of  venison.  If  no  one  was  in  the  house  to  receive 
it,  they  would  walk  in  stealthily  and  lay  it  on  Mrs. 
Reed's  dressing  table,  or,  perhaps,  take  a  picture 
from  the  wall  and  hang  the  venison  in  its  stead. 

With  all  Dr.  Reed's  gentleness  his  sense  of  per- 
sonal dignity  and  justice  was  strong  and  he  never 
allowed  anyone,  even  a  superior  officer,  to  infringe 


52      WALTER   REED   AND   YELLOW    FEVER 

upon  his  rights,  or  to  fail  in  treating  him  with  the 
respect  to  which  he  was  entitled.  Several  times 
during  his  garrison  life  he  had  reason  to  think  that 
the  commanding  officer  was  usurping  authority, 
and  he  at  once  appealed  to  the  higher  powers, 
knowing  that  he  was  in  the  right  and  that  an  un- 
biassed judgment  would  decide  in  his  favour. 
Once,  while  a  soldier  was  still  on  the  sick  list, 
the  commanding  officer  saw  him  taking  a  walk 
and  ordered  him  to  duty,  saying  that  if  he  was 
well  enough  to  be  out,  he  was  well  enough  to 
work.  Dr.  Reed's  anger  was  justly  roused,  but  his 
temper  was  always  under  his  control.  Without  al- 
lowing himself  to  speak,  he  sent  a  written  com- 
munication through  the  commanding  officer  to 
Headquarters,  asking  whether  such  interference 
was  allowed.  The  paper  was  promptly  returned 
through  the  proper  channels  to  the  commanding 
officer,  who  read  it  and  handed  it  to  his  adjutant 

to  be  forwarded  to  Dr.  Reed,  remarking,  "  D 

the  doctors,  Mr.  Adjutant,  we  can  never  get  ahead 
of  them." 

Dr.  Reed  took  the  greatest  interest  in  his  army 
hospitals  and  in  the  hospital  corps.  His  influence 
over  his  men  was  very  great  and  he  inspired  them 
with  his  own  enthusiasm,  so  that  order  and  neat- 
ness prevailed  wherever  he  ruled.  Cleanliness  is 
next  to  Godliness  was  his  motto.  Drinking  he 


FRONTIER   LIFE  53 

would  not  permit  under  any  circumstances  among 
the  hospital  attendants,  and  in  subsequent  years 
several  of  his  former  hospital  stewards  sought  him 
out  and  thanked  him  for  keeping  them  bound  to 
a  temperance  pledge  while  in  hospital  service. 

His  love  for  outdoor  sports  was  very  strong,  and 
a  Western  life  afforded  him  opportunities  of 
hunting,  which  he  greatly  enjoyed.  In  1879  his 
wife  went  back  East  to  spend  a  year  at  home,  and 
he  writes  to  her  as  follows  concerning  a  deer  hunt 
in  which  he  had  been  engaged : 

FORT  APACHE,  ARIZONA, 

December  23,  1879. 

My  last  letter  was  not  a  very  long  one  for  the 
reason  that  I  was  getting  ready  to  go  for  a  "  big 
hunt "  with  Lieutenants  Kingsbury  and  Cruse,  al- 
though I  did  not  mention  it  at  the  time.  Well,  we  got 
away  from  the  post  about  8  o'clock  on  Wednesday 
morning,  and  away  we  hied  to  "  Bonito  Fork,"  the 
scene  of  our  former  hunting  expedition,  on  which  occa- 
sion the  deer  we  killed  and  the  turkey  we  slew  would 
not  have  furnished  fresh  meat  for  many  days.  On  this 
occasion,  however,  beside  four  soldiers  and  four  pack- 
ers, we  had  twenty  of  the  Indian  Company,  so  that 
when  we  arrived  at  our  camp  that  afternoon  we  found 

four  turkeys  and  a  fine  big  deer  awaiting  us 

Our  little  camp  looked  real  pretty  at  night.  We  were 
on  the  extreme  right,  then  came  our  soldiers'  camp 
about  30  feet  away,  then  the  packers',  and  farther  still 


54      WALTER   REED   AND   YELLOW   FEVER 

the  20  Indians,  divided  into  two  camps  of  10  each", 
so  that  there  were  five  camp  fires  burning  brightly  and 
stretched  along  in  a  line  about  30  feet  apart.  We  had 
a  good  tent  for  ourselves  and  one  for  the  soldiers.  You 
should  have  seen  our  beds.  Lieutenant  Cruse  and  I 
dug  a  small  hole  on  each  side  of  the  tent  large  enough 
to  admit  our  backbones,  and  then  filled  both  of  them 
with  long  dry  grass  which  we  cut  from  the  mountain 
side,  thus  making  a  delightfully  soft  cushion  for  our 
bones — a  sort  of  hair  mattress  with  springs,  as  it  were, 
over  which  we  spread  our  blankets.  I  slept  with  4 
blankets  under  me  doubled  over,  and  8  over  me  with 
my  night-cap  and  a  good  heavy  comforter  which  Mrs. 
Harrison  gave  me  around  my  neck,  and  I  managed  to 
exclude  the  cold  pretty  well.  I  forgot  to  say  that  I  had 
Lieutenant  Kingsbury's  dog  sleeping  on  my  feet  to 
keep  them  warm,  and  pretty  cold  it  was  too.  Next 
morning  (Thursday)  when  we  got  up,  bright  and 
early,  we  found  about  half  an  inch  of  snow  on  the 
ground  and  the  wind  was  singing  merrily  through  the 
trees.  The  Indians  had  already  skipped  out  for  a  day's 
hunt,  and  while  we  ate  our  broiled  venison  for  break- 
fast we  now  and  then  heard  a  sharp  crack  of  a  rifle, 
which  we  knew  meant  either  a  turkey  or  a  deer.  After 
breakfast  was  over  (I  am  sorry  to  say  that  I  did  not 
wash  my  face  that  morning,  it  was  so  cold)  Lieutenant 
Cruse  and  I  took  our  guns  and  climbed  a  high  hill 
which  took  the  breath  clean  out  of  us  and  then  away 
we  went,  tramping  over  the  roughest  country  you  al- 
most ever  saw,  and  we  kept  our  walk  till  2  p.  M.,  but 
we  didn't  get  anything,  as  the  Indians  were  ahead  of 
us  and  frightened  all  the  game  away.  We  got  back  at 
2  P.  M.  to  camp,  and  such  a  dinner  as  we  two  ate  would 


FRONTIER   LIFE  55 

have  supplied  half  a  dozen  hungry  men.  .  .  .  By 
the  time  we  had  finished  the  Indians  began  to  come 
in  with  their  game,  and  before  the  sun  had  sunk  be- 
neath the  western  horizon  we  counted  13  deer  and  10 
turkeys  as  the  result  of  one  day's  shooting.  I  attended 
to  "  drawing  "  the  turkeys,  in  fact,  did  it  all  myself, 
and  Lieutenant  Kingsbury  superintended  cleaning  the 
deer.  Before  night  we  had  them  all  hung  up  on  a  rope 
stretched  between  two  tall  pines  and  by  the  light  glim- 
mer of  the  camp  fire  the  display  of  game  was  very 
fine.  ....  Next  morning  we  were  up  before  the 
stars  ceased  shining,  busy  taking  down  our  tent  and 
bundling  up  our  baggage  ready  for  a  day's  journey  to 
another  branch  of  Black  River,  about  7  miles  farther 
away.  We  were  there  and  in  camp  by  12  o'clock  noon, 
and  after  camp  was  pitched  we  lay  off  on  our  backs,  and 
snoozed  and  sang  songs  and  had  a  jolly  time  generally. 
That  afternoon  the  Indians  brought  in  5  turkeys  and 
6  deer  and  reported  that  they  had  left  hanging  out  in 
the  trees,  from  5  to  15  miles  away,  13  more  big  deer 
so  large  that  they  couldn't  pack  them  on  their  backs. 
That  night  we  had  a  glorious  time  broiling  venison 
over  the  red-hot  coals.  We  ate  and  ate  and  y/"t  did  not 
seem  to  have  enough.  We  held  a  council  of  war  that 
night  and  decided  to  send  in  to  the  post  next  morning 
1 6  deer  and  17  turkeys  as  a  gentle  reminder  to  the 
folks  at  Apache  that  we  were  as  good  hunters  as  other 
people.  After  getting  the  party  off  to  Apache  early 
next  morning  (Saturday)  we  started  in  various  direc- 
tions to  get  the  deer  that  were  hanging  out.  Sam  Bow- 
man and  I  went  out  with  two  pack  mules,  and  after 
travelling  about  5  miles  over  mountains  and  canons 
we  brought  in  4  beautiful  deer,  but  such  a  tramp  as  we 


56      WALTER   REED   AND   YELLOW   FEVER 

had.  The  Indian  who  went  to  show  us  where  the  deer 
were  said  that  it  was  only  "  poco  logos  "  that  is  "  a 
little  far"  (Dandy-Bill,  our  old  friend,  by  the  way, 
was  the  caballiero),  and  I  never  knew  what  "poco 
logos  "  was  before,  but  I  know  now.  It  means  about 
50  miles  for  a  white  man  I  I  was  so  tired  when  I  got 
back  to  camp  that  it  took  about  3  pounds  of  venison 
stew  to  refresh  my  drooping  spirits!  Saturday  night  it 
began  to  storm  and  rained  all  night,  and  continued  so 
to  do  all  day  Sunday,  so  that  no  hunting  could  be  done 
by  the  Indians.  All  day  we  lay  in  our  tents  with  a  roar- 
ing fire  in  front  and  did  not  have  to  go  out,  except  for 
meals,  which  even  the  storm  could  not  keep  us  from. 
.  .  .  .  We  concluded  that  night  that  our  hunt  was 
over,  as  the  storm  only  increased  in  severity  and  we 
only  waited  for  the  return  of  the  pack  mules  from 
Apache  in  order  to  pack  up  our  duds  and  hie  to  the 
camp.  They  returned  on  Monday,  too  late  for  a  start 
back  on  the  same  day.  On  Tuesday  morning  (yester- 
day), however,  we  started  back  again  to  Apache  and 

faced  a  terrible  storm  till  2  P.  M In  all  we 

killed  41  deer  and  50  turkeys!  This  morning  we  dis- 
tributed the  game  and  now  everyone  at  the  Post  has 
enough  fresh  meat  for  their  Christmas  dinner.  .  .  . 
A  thousand  Happy  New  Years  for  my  sweet  wife  and 
son!  God  bless  and  preserve  you  both  is  ever  the 
prayer  of  your  fond  and  devoted  husband, 

WALTER  OF  ARIZONA. 

At  the  end  of  four  years  in  Arizona,  Dr.  Reed 
was  ordered  East  again,  being  promoted  at  the 
same  time  to  the  rank  of  captain.  In  1881  he  was 


FRONTIER   LIFE  57 

stationed  for  a  short  time  at  Fort  McHenry,  Balti- 
more, and  while  there  made  use  of  the  opportunity 
to  study  physiology  at  the  Johns  Hopkins  Uni- 
versity. This  work  may  really  be  considered  his 
introduction  to  the  world  of  modern  scientific 
research,  and  it  was  during  this  period  that  he 
laid  the  foundations  of  his  future  distinction. 

In  1882  Dr.  Reed  was  transferred  to  the  De- 
partment of  the  Platte  and  stationed  in  Western 
Nebraska.  It  was  during  the  next  year,  while  he 
was  living  at  Fort  Omaha,  that  his  second  child, 
Emilie  Lawrence  Reed,  was  born,  on  July  12, 


While  serving  in  Nebraska,  Dr.  Reed  was  fre- 
quently called  on  to  practice  among  the  poor  set- 
tlers known  as  "  Grangers,"  who  eke  out  a 
wretched  subsistence  by  trying  to  farm  in  a  coun- 
try where  the  rainfall  is  barely  sufficient  for  a 
good  crop  once  in  three  years.  In  the  winters  he 
was  often  obliged  to  take  journeys  on  horseback  in 
the  discharge  of  his  professional  duties  that  were 
really  dangerous  from  the  risk  of  being  overtaken 
by  one  of  those  blizzards  in  which  the  most  ex- 
perienced frontiersman  cannot  see  his  way  and 
the  staunchest  horse  turns  tail,  so  that  the  lost 
traveller  is  in  greater  peril  than  he  would  be  on  a 
battlefield.  A  little  incident  occurred  on  one  of 
these  expeditions  which  Dr.  Reed  always  referred 


58      WALTER   REED   AND   YELLOW   FEVER 

to  with  amusement  as  an  instance  of  the  difference 

in  man's  "  point  of  view." 

He  was  sent  for  while  a  blizzard  was  raging 
and  the  thermometer  was  below  zero,  to  go  a 
distance  of  twelve  miles  to  see  a  sick  woman.  He 
started  at  sunset  in  a  driving  wind,  out  on  to  the 
open  prairie,  where  nothing  could  be  seen  but  a 
sheet  of  snow,  stretching  miles  and  miles  ahead  of 
him,  without  a  landmark  visible.  It  was  not  long 
before  he  lost  his  way,  and  wandered  about  aim- 
lessly until  midnight,  when  suddenly,  from  behind 
a  snowdrift,  a  little  beacon  of  light  appeared  and 
he  found  the  tiny  cabin  he  was  seeking.  The 
woman  was  very  ill,  and  he  could  not  leave  her 
till  the  next  afternoon,  during  which  time  the 
husband  did  his  best  to  entertain  him.  While  they 
were  sitting  before  a  rickety  three-legged  stove, 
waiting  for  some  coffee  to  boil,  the  old  man 
drawled  out,  "  Well,  Doc,  I  often  feels  sorry  for 
you  folks  at  the  post.  I  know  you  all  must  git 
powerful  lonely  sometimes."  The  post  consisted 
of  four  companies,  with  headquarters  and  the 
band ;  moreover,  it  was  situated  within  sight  of  the 
railroad  station;  and  Dr.  Reed,  with  the  recollec- 
tion of  it  in  his  mind,  was  at  that  very  moment 
commiserating  inwardly  the  utter  isolation  of  this 
poor  old  pair  in  their  remote  cabin. 

In  1887,  after  five  years  in  Nebraska,  Dr.  Reed 


WALTKR    REEU    IN     l88l 
From  a  photograph  taken  in  Washington,  D.  C.      ^Etat  31 


FRONTIER  LIFE  59 

was  ordered  to  Mount  Vernon  Barracks,  Ala- 
bama, and  his  delight  in  the  change  of  surround- 
ings was  intense.  After  the  barren  desolation  and 
trying  climate  of  Nebraska,  to  say  nothing  of  the 
still  worse  condition  of  things  in  Arizona,  the  sun- 
shine, showers,  and  abundant  vegetation  of  the 
South  were  a  never-ending  delight.  His  love  for 
nature  knew  no  bounds,  and  wherever  he  was 
stationed,  even  among  the  most  untoward  sur- 
roundings, he  would  manage  to  have  a  garden  full 
of  flowers  for  his  friends  and  of  fruit  and  vege- 
tables for  his  hospital.  It  was  a  familiar  sight  to 
see  him  returning  from  an  early  morning  visit 
laden  with  flowers  gathered  on  his  homeward 
way. 

He  had  a  great  admiration  for  the  magnolia  tree, 
indigenous  to  southern  Alabama,  and  once  trans- 
planted a  couple  of  them  into  the  hospital  yard; 
shortly  afterwards,  a  countryman,  observing  them, 
came  to  him  and  entreated  that  they  might  be  up- 
rooted, as  it  was  a  firm  belief  in  that  part  of  the 
country  that  if  a  transplanted  tree  lives,  some  mem- 
ber of  the  family  owning  it  will  die  within  the  year. 
Dr.  Reed,  greatly  amused,  set  to  work  immediately 
to  scour  the  woods  until  he  found  a  sufficient  num- 
ber of  small  magnolia  trees  to  set  out  a  whole 
row,  saying  that  he  would  teach  the  country  peo- 
ple a  lesson.  The  trees  lived,  and  no  member  of 


60     WALTER   REED   AND   YELLOW   FEVER 

the  family  died,  but  it  is  not  known  whether  the 
superstition  survived  or  not. 

In  1889  Dr.  Reed  began  to  feel  keenly  that  he 
needed  time  and  opportunity  for  study,  in  order 
to  keep  abreast  of  advances  in  medical  research. 
He  applied,  therefore,  for  leave  of  absence,  stat- 
ing his  reasons  for  doing  so  and  the  advantages  to 
himself  and  to  others  that  he  hoped  to  gain  from  it. 
The  reply  from  headquarters  was  that  if  he  would 
pay  the  salary  of  a  contract  surgeon  to  fill  his 
place  he  might  go.  This  was  a  bitter  disappoint- 
ment, but  fortunately  it  was  only  for  a  short  time. 
The  old  order  in  Washington  was  just  then  giv- 
ing place  to  new,  and  with  the  change  sufficient 
interest  was  manifested  in  his  application  to  in- 
sure his  appointment  as  Attending  Surgeon  and 
Examiner  of  Recruits  in  Baltimore,  with  permis- 
sion to  pursue  some  line  of  professional  work  at 
the  Johns  Hopkins  Hospital,  at  that  time  just 
opened  to  physicians  for  courses  in  clinical  medi- 
cine, surgery,  and  laboratory  work.  Even  then, 
however,  he  was  not  free  to  follow  his  own  incli- 
nations without  restriction.  He  consulted  the 
superintendent  of  the  hospital  as  to  his  best  line 
of  work,  and  was  advised  to  take  courses  in  pa- 
thology and  bacteriology  in  addition  to  certain 
clinical  work  in  general  medicine  and  surgery. 
Dr.  Reed  showed  great  interest  in  the  suggestion, 


FRONTIER  LIFE  61 

but  answered  with  regret  that  the  Surgeon-General 
had  forbidden  him  to  give  any  attention  to  labora- 
tory work  and  had  informed  him,  curtly  and 
pointedly,  that  the  object  of  the  Government  in 
detailing  him  for  service  in  Baltimore  was  that 
he  might  better  familiarise  himself  with  the  care 
of  sick  soldiers;  under  the  circumstances,  he  felt 
that  he  could  not,  in  honour,  pursue  any  laboratory 
courses.  He  began  his  work,  therefore,  exclu- 
sively on  the  clinical  side  of  the  hospital,  but 
fortunately  for  himself  and  for  the  country  he  was 
not  obliged  to  remain  there.  Surgeon-General 
Baxter  died  suddenly  a  few  weeks  later,  and  the 
new  Surgeon-General  was  much  more  in  sympathy 
with  scientific  pursuits,  so  that  after  obtaining  the 
necessary  permission,  Dr.  Reed  devoted  himself 
largely  to  pathology  and  bacteriology,  in  which 
lines  of  work  he  soon  became  known  as  a  worker 
of  the  utmost  promise.  The  quiet  years  of  practical 
work  on  the  frontier  had  furnished  an  admirable 
soil  for  the  development  of  his  talents,  and  they 
were  now  ready  to  yield  an  abundant  harvest. 


CHAPTER   III 

BEGINNING   OF   SCIENTIFIC   WORK 
1890-1899 

In  all  things  sought  to  see  the  Whole, 

Brooked  no  disguise; 
And  set  his  heart  upon  the  goal, 

Not  on  the  prize. 

— WILLIAM  WATSON,  Laleham  Churchyard. 

THE  winter  of  1890-91  was  one  of  the  keenest  en- 
joyment to  Dr.  Reed.  After  living  for  so  many 
years  at  a  distance  from  the  scientific  world  and 
cut  off  from  congenial  companionship,  he  re- 
turned to  both  with  delight.  His  work  at  the  Johns 
Hopkins  Hospital  brought  him  into  the  society 
of  cultivated,  scientific  men,  with  whom  his  own 
genial  nature  and  charming  manner  made  him 
universally  popular.  He  made  many  warm  friend- 
ships during  this  year  of  his  life,  among  which 
he  set  special  value  on  that  of  his  beloved  teacher, 
Professor  William  Welch. 

The  following  account  of  Dr.  Reed's  work  at 
the  Johns  Hopkins  University  and  Hospital  has 

been  kindly  supplied  me  by  Dr.  Welch : 

62 


SCIENTIFIC  WORK  63 

Dr.  Reed  was  sent  to  Baltimore  in  October,  1890, 
as  Attending  Surgeon  and  Examiner  of  Recruits,  and 
he  remained  there  until  the  following  October.  The 
Medical  Department  of  the  University  was  not  opened 
until  October,  1893,  but  the  Hospital  was  in  full  opera- 
tion in  1889,  and  the  Pathological  Laboratory  of  the 
Hospital  and  the  University  had  been  equipped  and 
opened  for  the  reception  of  physicians  and  advanced 
students  and  for  research  since  1885.  Here  systematic 
laboratory  courses  were  given  in  pathology  and  bac- 
teriology, and  it  was  here  that  Dr.  Reed  received  his 
fundamental  training  in  these  subjects. 

Dr.  Reed  began  his  work  on  the  clinical  side  of  the 
Hospital,  but  after  a  few  weeks,  a  new  Surgeon-Gen- 
eral having  in  the  meantime  been  appointed,  he  was 
enabled  to  follow  his  own  inclination  and  to  enter  the 
regular  courses  in  pathology  and  bacteriology  in  the 
Pathological  Laboratory.  I  well  recall  with  what 
eagerness  and  enthusiasm  he  turned  his  attention  to 
the  new  fields  of  scientific  medicine  thus  first  opened  to 
him,  which  from  that  time  until  the  end  of  his  life  be- 
came the  centre  of  his  professional  interest  and  activity, 
and  which  he  himself  was  destined  to  cultivate  with 
such  signal  benefits  to  medical  science  and  to  the 
welfare  of  mankind. 

The  decade  preceding  the  time  when  Dr.  Reed 
began  his  practical  studies  at  the  Johns  Hopkins  had 
been  a  period  of  marvellous  progress  in  our  knowledge 
of  infectious  diseases.  Upon  the  basis  of  the  discov- 
eries of  Pasteur  and  of  Koch,  and  particularly  as  a 
result  of  the  new  methods  introduced  by  Koch  for  the 
cultivation  and  study  of  bacteria,  there  had  followed 
in  rapid  succession  within  this  period^  such  important 


64     WALTER   REED   AND   YELLOW   FEVER 

discoveries  as  those  of  the  specific  germs  causing  tuber- 
culosis, cholera,  leprosy,  glanders,  erysipelas,  surgical 
infections,  tetanus,  pneumonia,  typhoid  fever,  malaria, 
amoebic  dysentery,  cerebro-spinal  meningitis,  diph- 
theria, and  a  large  number  of  animal  diseases.  Pasteur 
had  discovered  methods  of  rendering  animals  arti- 
ficially immune  from  chicken-cholera  and  other  dis- 
eases, and  had  devised  his  method  of  protective  inoc- 
ulation against  rabies,  which  has  been  the  means  of 
saving  many  human  lives.  A  great  impetus  was  given 
by  these  discoveries  to  the  establishment  of  hygienic 
and  other  laboratories  where  the  new  science  of  bac- 
teriology was  actively  cultivated.  Medicine,  both  as  a 
science  and  an  art,  had  entered  upon  a  new  era,  already 
rich  in  achievement  and  still  richer  in  promise  of  future 
good. 

While  Dr.  Reed  took  the  regular  courses  in  pathol- 
ogy given  in  the  laboratory  and  was  interested  in  the 
subject,  his  special  object  was  bacteriology,  which  is 
included  in  the  Department  of  Pathology.  In  the  con- 
duct of  these  courses  there  were  associated  with  me 
at  that  time,  Drs.  Councilman,  Abbott,  Nuttall,  and 
Flexner;  and  among  others  then  engaged  in  research 
work  in  the  laboratory  I  call  to  mind,  Drs.  Halsted, 
Lafleur,  H.  M.  Thomas,  Berkeley,  W.  T.  Howard, 
Jr.,  Barker,  Robb,  Ghriskey,  Randolph,  Clement, 
Blackstein,  Gilchrist,  and  Thayer. 

Dr.  Reed  soon  made  a  place  for  himself  in  this  in- 
timate group  of  active  workers.  We  early  recognised 
that  he  possessed  unusual  aptitude  for  the  work  which 
he  had  undertaken,  and  that  he  combined  with  excel- 
lent endowment  of  mind  a  sincere,  manly,  and  winning 
personality.  The  friendships  formed  with  his  teachers 


SCIENTIFIC   WORK  65 

and  co-workers  at  this  period  were  strong  and  en- 
during. 

Dr.  Reed  applied  himself  with  great  energy  to  his 
work  in  the  laboratory,  devoting  to  it  daily  a  large  part 
of  his  time  and  carrying  it  much  beyond  the.  regular 
class  exercises.  After  he  had  acquired  familiarity  with 
technical  methods,  he  undertook  advanced  and  inde- 
pendent work.  He  attended  post-mortem  examinations 
and  sometimes  conducted  them;  moreover,  he  was  ac- 
customed to  study  for  himself  pathological  material 
and  cultures  which  he  had  obtained  from  autopsies. 
He  followed  and  profited  by  the  various  investigations 
which  were  at  that  time  in  progress  in  the  laboratory 
and  the  Hospital,  and  he  was  a  regular  attendant  at 
the  Hospital  Medical  Societies.  Drs.  Abbott,  Flexner, 
and  I  were  at  that  time  engaged  in  the  study  of  diph- 
theria, the  toxin  of  which  had  been  discovered  two 
years  previously,  and  the  antitoxin  of  which  was  dis- 
covered by  Behring  in  1890.  The  investigations  of 
hog-cholera  made  at  this  time  by  Dr.  Clement  and 
myself  enabled  Dr.  Reed  to  become  familiar  with  the 
hog-cholera  bacillus,  so  that  he  had  no  difficulty  later 
in  recognising  the  resemblance  to  this  bacillus  of  the 
micro-organism  erroneously  claimed  by  Sanarelli  to  be 
the  cause  of  yellow  fever.  He  also  followed  with  great 
interest  the  studies  of  Drs.  Councilman  and  Lafleur  on 
amoebic  dysentery,  as  well  as  investigations  in  the 
Hospital  on  the  malarial  parasite. 

During  the  latter  part  of  his  stay  in  Baltimore  Dr. 
Reed  was  assigned,  at  his  own  request,  a  special  subject 
for  research.  This  was  the  microscopical  and  experi- 
mental study  of  the  so-called  lymphoid  nodules  which 
are  found  in  the  liver  in  cases  of  typhoid  fever.  He 


66      WALTER   REED   AND   YELLOW   FEVER 

succeeded  in  producing  these  nodules  experimentally 
and  demonstrated  that  they  originated  as  small  foci  of 
dead  liver  cells.  His  paper  upon  this  subject,  published 
in  the  Reports  of  the  Johns  Hopkins  Hospital,  is  a 
valuable  contribution,  and  it  embodies  the  results  of  his 
first  original  scientific  investigation.1 

When  Dr.  Reed  left  Baltimore  in  October,  1891,  he 
was  well  trained  in  pathological  and  bacteriological 
methods,  he  had  acquired  a  considerable  amount  of  ex- 
perience, and  he  was  thoroughly  fitted  to  make  the  best 
use  of  such  opportunities  as  might  present  themselves 
to  add  to  this  experience  and  training,  as  well  as  to 
undertake  original  investigation.  This  was  apparent  to 
us  at  the  time  and  was  fully  demonstrated  by  his  sub- 
sequent career. 

In  1893,  when  Dr.  Reed  was  assigned  to  duty  as 
curator  of  the  Army  Medical  Museum  and  professor 
of  bacteriology  and  clinical  microscopy  in  the  Army 
Medical  School,  he  at  once  re-established  relations 
with  the  Pathological  Laboratory  in  Baltimore.  He 
was  a  frequent  visitor,  together  with  his  associate,  Dr. 
Carroll,  at  the  laboratory,  and  he  kept  in  touch  with 
the  men  and  the  work  there.  He  often  came  to  the 
Hospital  Medical  Society,  at  which  he  occasionally 
made  contributions.  I  was  often  consulted  by  him  re- 
garding his  own  investigations,  and  his  relations 
were  likewise  very  intimate  and  cordial  with  Drs.  Flex- 
ner,  Abbott,  and  Thayer.  He  talked  over  with  me  the 
plan  of  the  yellow  fever  work  to  be  undertaken  by  the 
commission  of  which  he  was  the  head,  and  he  kept  me 
informed  by  letter  and  by  conversation  of  the  results 
of  this  work  while  it  was  in  progress. 

1  Johns  Hopkins  Hosp.  Rep.,  1895,  vol.  5,  p.  379. 


SCIENTIFIC  WORK  67 

It  is  one  of  the  greatest  satisfactions  and  pleasures 
of  my  life  to  have  enjoyed  the  relations  of  teacher  and 
of  friend  with  a  man  who  has  left  a  memory  so  re- 
spected and  beloved,  and  who  has  conferred  such 
inestimable  benefits  upon  his  country  and  upon  mankind 
as  Dr.  Reed.  , 

In  October,  1891,  Reed  was  sent  to  Dakota, 
and  remained  there  until  1893,  when  he  was 
ordered  to  duty  in  the  office  of  the  Surgeon-Gen- 
eral in  Washington.  There  he  was  made  curator 
of  the  Army  Medical  Museum  and  professor  of 
bacteriology  and  clinical  microscopy  in  the 
United  States  Army  Medical  School,  then  just 
organised,  and  was  at  the  same  time  promoted  to 
be  full  surgeon  with  the  rank  of  major.  With 
this  promotion  his  garrison  life  ended,  after  last- 
ing eighteen  years  and  including  fifteen  changes 
of  station.  Its  influence  on  his  own  life  and 
character  is  best  described  in  the  words  of  friends 
who  speak  from  personal  knowledge  of  him  and 
of  his  environment  during  this  period. 

Dr.  McCaw,  in  his  excellent  memoir  of  Dr. 
Reed,  writes  on  the  subject  thus: 

For  a  man  like  Reed,  already  an  earnest  student,  no 
better  preparation  for  his  future  could  perhaps  have 
been  made.  His  early  army  service  must  have  singu- 
larly tended  to  develop  in  him  the  very  qualities  most 
necessary  to  his  final  success.  To  the  end  of  his  life  it 
was  noticeable  that,  even  when  he  had  long  given  up 


68      WALTER   REED   AND   YELLOW   FEVER 

the  practice  of  medicine  for  the  work  of  the  labora- 
tory, he  was,  nevertheless,  unexcelled  at  the  bedside 
for  unerring  diagnosis  and  sound  judgment  in  treat- 
ment. So  also  were  the  experiments  which  robbed 
yellow  fever  of  its  terrors  especially  remarkable  for 
simplicity,  accuracy,  and  completeness,  or  they  would 
never  have  so  quickly  convinced  the  world  of  their 
truth.  Too  much  reverence  for  accepted  teaching  and 
too  little  experience  in  grappling  with  difficulties  unas- 
sisted, and  they  might  never  have  been  conceived. 

Major  J.  R.  Kean  spoke  to  the  same  effect  as 
follows  at  the  memorial  services  held  in  memory 
of  Dr.  Reed  at  Washington,  in  December,  1902: 

In  speaking  of  Dr.  Reed  as  a  medical  officer  we 
should  consider  especially  that  part  of  his  career  with 
which  the  members  are  least  familiar,  namely,  from 
his  entrance  into  the  army,  in  1875,  to  his  assignment 
to  duty  in  Washington,  in  1893.  With  the  latter  date 
began  his  career  as  a  scientific  man,  although  much  of 
his  time  during  the  last  decade  was  given  to  examining 
boards  and  other  work  of  a  military  rather  than  a 
scientific  character,  and  the  race  horse  spent  much  time 
at  the  plough.  These  eighteen  years  of  garrison  duty 
were,  we  may  be  sure,  not  wasted,  yet  the  official 
records  tell  us  but  little  of  them.  .  .  .  The  work  of 
young  army  surgeons  claims  little  space  in  the  gazettes 
or  in  the  reports  of  military  commanders,  and  in  the 
seventies  and  eighties  the  life  was  certainly  not  stimu- 
lating to  intellectual  effort. 

The  surgeon  shared  with  his  comrades  of  the  line 


SCIENTIFIC  WORK  69 

the  tedium  of  marches  and  the  monotonous  sameness 
of  Arizona  summers  and  Dakota  winters.  And  those 
with  whom  bonne  camaraderie  outweighed  studious 
industry  shared  alike  the  afternoons  of  bottle-pool  and 
beer,  and  the  nightly  seductions  of  draw-poker.  But 
for  medical  officers  it  was  redeemed  by  the  study  of 
our  profession,  which  was  then  beginning  to  broaden 
out  from  ancient  channels  into  the  full  flood  of  recent 
progress,  and  it  was  saved  from  triviality  by  those 
stern  responsibilities  of  life  and  death  which  practice 
brings  to  all  physicians.  To  lesser  minds  the  limita- 
tions of  such  a  life  must  have  been  narrowing,  but  for 
the  eager  industry  and  professional  devotion  of  a  Reed 
they  made  the  roots  strike  deep;  and  when  we  are  sur- 
prised at  the  rapid  growth  and  splendid  fruit  of  his 
career  as  a  scientist,  we  must  remember  that  in  the 
post-surgeon's  unmarked  life  the  seed  was  germinated 
and  the  roots  firmly  set.  But  for  the  opportunities 
given  him  by  his  position  in  the  army,  however  dis- 
tinguished he  might  have  become  in  other  ways,  it  is 
safe  to  say  that  the  work  with  which  his  fame  will 
always  be  inseparably  connected  would  never  have  been 
accomplished  by  him.  During  that  long  apprentice- 
ship he  acquired,  too,  that  perfect  familiarity  with  the 
conditions  and  limitations  of  army  life  which,  com- 
bined with  his  scientific  knowledge  and  sound  judg- 
ment, made  him  the  best  sanitary  inspector  in  the  army 
and  the  court  of  last  resort  on  all  sanitary  questions. 

Dr.  Reed's  paper  on  "The  Contagiousness  of 
Erysipelas"  was  published  in  1892,  and  from 
this  time  forward  he  was  a  constant  contributor  to 


70      WALTER   REED   AND   YELLOW   FEVER 

medical  periodicals,  where  his  literary  work  shows 
the  same  excellence  as  everything  else  to  which 
he  put  his  hand.  A  full  list  of  his  publications  is 
given  at  the  end  of  this  volume.  They  stand  as 
witness  to  the  indomitable  energy  and  persever- 
ance of  the  man  as  well  as  to  his  unusual  intel- 
lectual endowments,  for  it  must  be  remembered, 
that  not  only  were  these  papers  written  during 
a  single  decade,  but  that  the  scientific  researches 
which  they  record  were  all  executed  during  the 
same  space  of  time. 

The  discovery  of  the  Klebs-Loeffler  bacillus  was 
a  matter  of  extreme  interest  to  Dr.  Reed,  and  he 
used  every  means  in  his  power  to  advance  the 
practical  benefits  attendant  on  its  demonstration. 
Early  in  1894  he  was  invited  by  the  Medical  So- 
ciety of  the  District  of  Columbia  to  open  the  dis- 
cussion on  a  paper  by  Dr.  Kinyoun,  entitled,  "  The 
Prevention  and  Control  of  Diphtheria";  he  con- 
ducted the  debate  with  great  earnestness  and  ad- 
mirable command  of  the  subject.  He  firmly  be- 
lieved that  the  Klebs-Loeffler  bacillus  was  the 
cause  of  primary  diphtheria,  and  that  the  disease 
was  a  local  one,  tending  to  become  constitutional 
by  the  production  of  virulent  toxins.  A  year  later, 
January,  1895,  m  discussing  diphtheria  and  its 
treatment  by  antitoxin,  he  said  that  he  believed 
the  production  of  antitoxin  should  be  under  mu- 


SCIENTIFIC   WORK  71 

nicipal  control  and  the  serum  tested  by  disin- 
terested persons,  so  as  to  avoid  imposition  by 
unscrupulous  men,  actuated  by  the  love  of  gain. 
On  December  4,  1895,  ne  struck  the  deathblow 
to  the  local  opponents  of  antitoxin  in  a  discussion 
on  "  The  Clinical  Aspects  of  Diphtheria  "  before 
the  Medical  Society  in  Washington.  The  presi- 
dent, Dr.  S.  S.  Adams,  thus  describes  the  occasion: 

A  clinician  of  wide  experience  and  recognised  ability, 
while  disclaiming  any  unfriendliness  towards  its  use, 
had  taken  a  decided  stand  against  this  serum,  basing 
his  remarks  upon  the  statistics  and  arguments  of  a 
distinguished  English  laryngologist  and  a  well-known 
American  pediatrist.  It  seemed  as  if  the  pendulum 
were  swinging  toward  the  opposition  when  Walter 
Reed  entered  the  forum — majestic,  fearless,  deter- 
mined to  conquer.  With  keen  eyes  fixed  on  his  princi- 
pal antagonist,  he  hurled  his  weapon  of  defence  in  un- 
mistakable language,  when  he  said:  "You  are  theo- 
rising, while  we  are  dealing  with  facts.  If  another 
friend  of  antitoxin  arises  and  deals  it  such  blows  as 

Doctor has  given  it,  the  antitoxin-serum  will  be 

slaughtered  in  the  house  of  its  friends."  In  concluding 
his  remarks  came  this  appeal :  "  I  myself  almost  feel 
like  saying,  with  the  reader  of  the  paper,  that  the 
failure  to  use  it  in  a  case  of  human  diphtheria  is  crimi- 
nal ;  and  I  beg  of  you,  that  if  you  have  not  yet  done  so, 
when  next  you  stand  by  the  bedside  of  your  patient 
afflicted  with  this  disease,  you  do  not,  through  any  fear 
of  its  peculiar  action,  withhold  this  invaluable  remedy." 


72      WALTER   REED   AND   YELLOW   FEVER 

In  1898,  when  the  Spanish-American  War 
broke  out,  Dr.  Reed  became  extremely  anxious  to 
hold  some  responsible  position  in  charge  of  sick 
soldiers.  He  knew  that  his  experience  peculiarly 
fitted  him  to  do  this  work,  since  he  was  familiar 
with  practical  matters,  such  as  the  condition  of  the 
army,  the  routine  of  getting  supplies,  the  manner 
of  preserving  the  health  of  the  soldiers,  and  all 
questions  of  general  management,  which  were  un- 
known to  the  civilian  physicians  and  political 
doctors  appointed  to  hold  responsible  positions 
over  him.  He  made  a  strong  effort  to  secure  some 
such  appointment,  for  which  years  of  army  work 
had  so  admirably  fitted  him,  only  to  be  chagrined 
and  distressed  when  men  with  political  influ- 
ence were  preferred,  while  he  and  other  army 
surgeons  were  relegated  to  other  unimportant 
positions.  The  records  of  our  camps  during  the 
Spanish-American  War  afford,  indeed,  a  val- 
uable object  lesson  on  the  evils  of  allowing 
matters  in  which  human  safety  depends  upon 
technical  knowledge  and  specialised  training  to 
be  governed  by  political  interest.  For,  not  only 
is  human  life,  under  such  conditions,  at  the  mercy 
of  ignorance,  indifference,  and  greed,  but  the  very 
men  whose  hands  are  tied  by  political  usurpation 
of  authority  which  should  be  theirs,  are  liable  to 
undeserved  blame  for  the  evils  they  have  striven 


SCIENTIFIC   WORK  73 

to  prevent,  and  our  credit  as  a  nation  suffers  in 
consequence. 

No  one  felt  this  injustice  more  keenly  than  Dr. 
Reed;  and  in  a  conversation  with  a  friend  soon 
after  the  war  was  over,  he  spoke  with  extreme  sad- 
ness of  the  fact  that  by  such  mismanagement  on 
the  part  of  the  Secretary  of  War  and  others  who 
should  know  better,  the  Army  Medical  Corps  had 
been  subjected  to  censure  which  it  did  not  deserve. 
To  use  his  own  words,  "  The  Army  Medical  Corps 
has  received  a  black  eye  because  of  the  neglect  and 
incompetence  of  men  who  did  not  really  belong 
to  it." 

The  knowledge  gained  by  our  experience  in 
Cuba  and  in  our  own  Southern  States  shows  only 
too  plainly  that  there  is  but  one  remedy  for  such 
a  state  of  things,  and  that  a  radical  one,  namely, 
the  entire  reorganisation  of  the  Army  Medical 
Corps  with  the  object  of  investing  it  with  au- 
thority necessary  to  carry  out  the  measures  and 
regulations  which  it  enacts.  So  long  as  the  Army 
Medical  Corps  is  subject,  in  hygienic  and  sani- 
tary matters,  to  the  will  of  ignorant,  inefficient,  or 
unprincipled  military  officials,  no  improvement 
can  be  expected.  During  our  recent  war  the  army 
surgeon  could  recommend  proper  sanitary  regula- 
tions, but  he  had  no  authority  to  enforce  his 
recommendations.  The  value  of  camp  cleanliness, 


74     WALTER   REED   AND  YELLOW   FEVER 

pure  water,  and  adequate  sanitary  arrangements 
might  be  appreciated  by  the  medical  authorities, 
but  so  long  as  the  military  officials  refused  to 
co-operate  they  were  powerless  to  enforce  the 
necessary  regulations.  If  the  military  commander 
issued  orders  to  enforce  sanitary  regulations  they 
were  carried  out;  but  if  not,  they  never  went  into 
effect,  no  matter  how  great  the  need  for  them 
might  be.  The  mortality  and  suffering  which  re- 
sulted from  this  state  of  things  would,  it  might  be 
thought,  have  resulted  in  some  measures  for  im- 
provement, but  no  steps  towards  it  have  as  yet  been 
taken.  Nothing,  indeed,  but  a  complete  reorgan- 
isation of  all  matters  connected  with  the  medical 
department  of  the  United  States  Army  can  pro- 
duce any  lasting  benefit;  and  until  this  is  done  we 
are  at  the  mercy,  should  war  again  be  our  fate,  of 
the  same  ravages  from  disease  which  have  already 
cost  us  so  dear. 

When,  owing  to  the  ignorance  of  untrained 
officials  and  the  lack  of  organisation  and  method, 
typhoid  fever  broke  out  among  the  volunteer 
troops,  Dr.  Reed  was  made  chairman  of  a  com- 
mittee to  study  its  causation  and  modes  of  propa- 
gation. The  other  members  were,  Dr.  V.  C. 
Vaughan  of  the  University  of  Michigan  and  Dr.  E. 
O.  Shakespeare  of  Philadelphia.  The  investiga- 
tion, which  covered  more  than  a  year,  was  re- 


SCIENTIFIC  WORK  75 

markable  for  the  patience  and  skill  with  which  a 
vast  number  of  details  were  collected  and  studied, 
and  it  marks  a  great  advance  in  our  knowledge  of 
the  disease.  The  report  of  the  committee,  under 
the  title  "  Report  of  the  Origin  and  Spread  of 
Typhoid  Fever  in  the  .United  States  Military 
Camps  during  the  Spanish-American  War  of 
1898,"  has  only  recently  been  issued  by  Govern- 
ment, for  its  publication  required  not  only  a  con- 
siderable amount  of  time  and  work  in  order  that 
so  vast  an  amount  of  data  might  be  available  to 
the  profession  at  large,  but  also  demanded  a 
liberal  expenditure  of  money.  The  labor  required 
has  been  supplied  by  the  sole  surviving  member 
of  the  board,  Dr.  Vaughan,  and  the  appropriation 
by  Congress  of  the  necessary  funds  is  due,  in  large 
measure,  to  the  interest  and  appreciation  of  the 
former  Secretary  of  War,  Mr.  Elihu  Root. 

The  report  is  issued  in  two  large  volumes,  the 
first  of  which  contains  the  reports  on  typhoid  fever 
in  all  the  different  army  divisions,  with  plots  of 
distribution  of  regiments,  regimental  lists,  tem- 
perature charts,  and  the  conclusions  reached  after 
a  careful  study  of  the  results;  the  second  volume 
contains  maps  of  the  country  over  which  typhoid 
fever  was  distributed.  The  book  is  a  monumental 
work,  which  will  always  be  of  value  as  a  basis  of 
future  study  in  the  epidemiology  of  typhoid  fever. 


76      WALTER   REED   AND   YELLOW   FEVER 

The  most  original  and  interesting  point  in  the  in- 
vestigation is  the  proof  that  the  infection  of  typhoid 
fever  is  spread  in  camps  by  the  common  fly  and 
by  contact  with  patients  and  infected  articles, 
such  as  clothing,  tentage,  and  utensils  of  all  kinds, 
as  well  as  by  contaminated  drinking  water.  Space 
forbids  me  to  quote  from  it  at  length,  but  I  give 
one  or  two  extracts  from  the  general  statements 
and  conclusions  at  its  close. 

Section  27 — Infected  water  was  not  an  important 
factor  in  the  spread  of  typhoid  fever  in  the  national 
encampments  in  1898. 

There  were  probably  local  water  supplies  that  be- 
came specifically  infected  with  the  typhoid  fever  bacil- 
lus, but  infected  water  was  not  the  great  factor  in  the 
causation  of  this  disease.  It  is  possible  that  the  piped 
water  at  Chickamauga  became  specifically  contami- 
nated. .  .  .  However,  that  even  at  Chickamauga  in- 
fected water  was  not  the  chief  factor  in  the  spread  of 
typhoid  fever  is  shown  by  the  fact  that  regiments 
which  did  not  drink  piped  water  also  became  widely 
infected  with  the  disease,  and  it  is  furthermore  demon- 
strated by  the  fact  that  the  spread  of  typhoid  fever 
continued  after  the  regiments  had  been  moved  to 
Knoxville,  Tenn.,  and  Lexington,  Ky.,  at  both  which 
places  the  water  supply  was  above  suspicion/ 

Section  28 — Flies  undoubtedly  acted  as  carriers  of 
the  infection. 

Flies  swarmed  over  the  infected  fecal  matter  in  the 
pits,  and  then  visited  and  fed  upon  the  food  prepared 
for  the  soldiers  at  the  mess  tents.  In  some  instances 


SCIENTIFIC   WORK  77 

where  lime  had  .been  sprinkled  over  the  contents  of 
the  pits  flies  with  their  feet  whitened  with  lime  were 
seen  walking  over  the  food.  It  is  possible  for  the  fly 
to  carry  the  typhoid  infection  in  two  ways.  In  the  first 
place,  the  fecal  matter  containing  the  germ  may  adhere 
to  the  fly  and  be  mechanically  transported.  In  the 
second  place,  it  is  possible  that  the  typhoid  bacillus 
may  be  deposited  with  its  excrement.  Since  the  above 
was  written  Hamilton  has  demonstrated  that  the 
house  fly  may,  and  does  at  times,  transport  the  typhoid 
bacillus.  .  .  .  Fischer  (Arch.  f.  Hygiene,  Bd.  46, 
s.  274)  has  attempted  to  determine  the  duration  of 
life  of  the  typhoid  bacillus  in  the  bodies  of  flies  fed  on 
infected  material,  and  places  it  at  twenty-three  days. 

Section  29 — It  is  more  than  likely  that  men  trans- 
ported infected  material  on  their  persons,  or  in  their 
clothing,  and  thus  disseminated  the  disease. 

We  have  condemned  the  method  which  was  fol- 
lowed in  many  of  the  camps,  of  detailing  men  from  the 
ranks  to  act  as  orderlies  at  the  hospitals.  In  some  of 
the  commands  it  was  customary  to  detail  100  or  more 
men  from  the  line  every  morning.  The  most  of  these 
men  were  wholly  ignorant  of  the  nature  of  infection 
and  the  methods  of  disinfection.  In  fact,  at  one  of  the 
division  hospitals  we  saw  orderlies  of  this  kind  go  from 
the  hospital  and  partake  of  their  midday  meal  without 
even  washing  their  hands.  These  men  handled  not 
only  the  food  they  ate,  but  passed  articles  to  their 
neighbours.  It  seems  to  us  that  a  more  certain  method 
for  the  dissemination  of  an  infectious  disease  could 
hardly  have  been  invented. 

Section  30 — Typhoid  fever,  as  it  developed  in  the 
regimental  organisation,  was  characterised  by  a  series 


78      WALTER   REED   AND   YELLOW   FEVER 

of  company  epidemics,  each  one  having  more  or  less 
perfectly  its  own  individual  characteristics. 

The  truth  of  this  statement  will  be  evident  after  the 
inspection  of  the  charts  showing  the  distribution  of 
typhoid  fever  among  the  companies  of  the  different 
regiments.  .  .  .  Certain  tents  were  badly  infected 
and  the  majority  of  all  their  inmates  developed  the 
disease,  while  other  tents  wholly  escaped.  Blankets 
and  tentage  became  soiled  with  typhoid  discharges, 
and  in  this  way  the  disease  was  propagated  and  carried 
by  the  company  wherever  it  went.  We  believe,  there- 
fore, that  personal  contact  was  a  very  important  factor, 
probably  the  most  important,  in  the  spread  of  the  dis- 
ease. That  the  floors,  furniture,  and  bedding  of  bar- 
racks may  become  infected  with  typhoid  fever,  and 
may  continue  to  endanger  the  life  and  health  of  the 
occupants  for  a  long  time  is  abundantly  shown  in  the 
records  of  military  surgeons.  .  .  .  Our  investiga- 
tions certainly  demonstrate  that  typhoid  fever  is  not 
only  an  infectious,  but  also  a  contagious  disease;  that 
It  may  be  transmitted  from  one  person  to  another  by 
contact,  and  that  the  clothing,  bedding,  and  rooms  of 
typhoid  patients  should  be  disinfected  with  as  much 
care  as  is  now  given  to  these  matters  in  cases  of  diph- 
theria and  scarlet  fever. 

Section  31 — It  is  probable  that  the  infection  was 
disseminated  to  some  extent  through  the  air  in  the  form 
of  dust. 

.  .  .  The  shell  roads  through  the  encampments  at 
Jacksonville  were  ground  by  the  heavy  army  waggons 
into  an  impalpable  dust  several  inches  thick.  Along 
these  roads  scavengers  carted  in  half  barrels  fecal 
matter  containing  the  typhoid  bacillus.  The  contents  of 


SCIENTIFIC   WORK  79 

these  tubs  splashed  and  fell  in  the  dust.  On  each  side 
of  these  roads  soldiers  were  encamped,  and  many  din- 
ing tables  were  in  close  proximity  to  the  roads. 
Local  whirlwinds  sometimes  caught  up  large  quantities 
of  this  dust  and  carried  it  considerable  distances.  After 
seeing  these  things  we  feel  that  we  cannot  exclude  dust 
as  a  probable  carrier  of  infection,  notwithstanding  the 
fact  that  it  would  probably  be  a  very  difficult  thing  to 
demonstrate  scientifically  that  the  disease  was  dissem- 
inated in  this  way. 

In  1899,  when  the  work  of  the  Typhoid  Commis- 
sion was  completed,  Dr.  Reed  returned  to  Wash- 
ington. Shortly  afterward  he  was  called  upon  to 
undertake  investigations  which  really  represent 
the  first  stage  of  his  work  in  yellow  fever,  but 
before  we  take  up  the  consideration  of  this,  the 
central  event  of  his  life,  let  us  pause  for  a  moment 
to  review  the  history  of  yellow  fever  in  the  past, 
in  order  that  we  may  form  a  just  conception  of  the 
condition  of  knowledge  regarding  it  at  the  time 
the  Yellow  Fever  Commission  began  its  work. 


CHAPTER   IV 
HISTORY  OF  YELLOW  FEVER  IN  THE  PAST 

"  Miserandaque  venit 
.     .     .     lues,  et  lethifer  annus, 
Linquebant  dulces  animas,  aut  aegra  trahebant  corpora." 

— VIRGIL,  JEneid,  Book  III. 

YELLOW  FEVER  was  described  by  Osier  in 
1892  as  "  an  acute  febrile  disorder  of  tropical  or 
subtropical  climates,  characterised  by  jaundice 
and  hemorrhages,  and  due  to  the  action  of  a  spe- 
cific virus,  the  nature  of  which  is  not  yet  known." 1 
The  course  of  the  disease,  according  to  the  same 
authority,  is  distinguished  by  a  sudden  onset  with- 
out previous  symptoms.  There  is  frequently  an 
initial  chill,  associated  with  headache  and  pain  in 
the  back  and  limbs,  nausea  and  vomiting,  constipa- 
tion, and  diminished  urinary  secretion.  This  first, 
or  febrile,  stage  lasts  from  a  few  hours  to  a  few 
days,  and  may  or  may  not  be  accompanied  by  the 
jaundice  which  gives  the  disease  its  name.  It  is  fol- 
lowed by  a  remission,  sometimes  known  as  the  stage 
of  calm,  during  which  the  temperature  falls,  and 
the  severity  of  the  symptoms  subsides.  In  favour- 
able cases  the  disease  now  decreases  and  convales- 

1 "  Practice  of  Medicine,"  1892,  p.  125. 
80 


HISTORY   OF   YELLOW   FEVER  81 

cence  sets  in.  In  other  instances,  the  third  stage, 
known  as  febrile  reaction,  begins.  The  tempera- 
ture again  rises,  all  the  symptoms  become  aggra- 
vated, the  jaundice  develops  rapidly,  and  in 
many  cases  the  symptom  called  "  black  vomit " 
takes  place;  this  is  the  ejection  of  blood  and 
gastric  mucus  altered  by  the  acid  juices  of 
the  stomach.  Black  vomit  is  usually  regarded  as  a 
symptom  belonging  distinctively  to  yellow  fever, 
but  such  is  not  the  case,  since  material  identical 
with  it  is  brought  up  under  other  febrile  condi- 
tions in  which  vomiting  of  blood  occurs.  It  is  not, 
therefore,  necessarily  a  fatal  symptom  in  yellow 
fever,  though  it  is  present  only  in  the  severer  forms 
of  the  disease.  Bleeding  sometimes  occurs  from  the 
gums  and  from  the  kidneys,  while  haemorrhages 
into  the  skin  are  not  uncommon.  The  mortality  in 
yellow  fever  is  very  high,  having  ranged  in  differ- 
ent countries  from  15  to  85  per  cent.  Convalescence 
is  slow  or  rapid,  according  to  the  severity  of  the 
disease,  and,  in  most  cases,  one  attack  insures 
against  another. 

In  the  treatment  of  yellow  fever  almost  every 
known  measure  under  the  sun  has  been  tried  at 
different  times,  with  indifferent  success.  Even  in- 
oculation with  the  poison  of  the  rattlesnake  was 
employed  at  Havana  many  years  ago,  and  was 
asserted  by  some  persons  to  have  been  of  consid- 


82     WALTER   REED   AND  YELLOW   FEVER 

erable  value  in  certain  forms  of  the  disease.  But 
this  question,  once  of  vital  interest,  has  become  of 
secondary  importance  now  that  the  prevention  or 
extinction  of  the  disease  has  been  shown  to  be  possi- 
ble. The  forms  of  treatment  which  our  present 
knowledge  shows  to  be  most  profitable  are  given 
in  Chapter  XI,  with  other  records  of  Dr.  James 
Carroll's  work. 

Some  of  the  older  writers  have  objected  to  the 
name  "  yellow  fever  "  (fievre  jaune  in  French  and 
fiebre  amarilla  in  Spanish)  because  the  yellow 
tinge  of  the  skin  from  which  it  is  derived  is  present 
also  in  bilious  fever.  The  name  in  common  use 
among  the  Spaniards,  "el  vomito  negro"  is,  per- 
haps, a  better  term. 

At  different  periods  in  the  earth's  history  both 
the  old  world  and  the  new  have  been  scourged  by 
epidemics  of  yellow  fever,  which  have  never  been 
arrested  by  any  of  the  means  employed  for  the  pur- 
pose. On  every  occasion  the  disease  has  run  its 
course  unhindered,  the  only  fact  clearly  determined 
being  that  its  abatement  was  always  preceded  by 
cooler  weather. 

Some  of  the  older  writers  claim  that  yellow 
fever  was  originally  present  in  Africa,  though 
Cortes  found  it  in  Mexico,  where  it  was  known  as 
matzlahuatt.  It  was  certainly  unknown  in  Europe 
until  after  the  discovery  of  America  by  Columbus. 


HISTORY   OF   YELLOW   FEVER  83 

The  earliest  authentic  instance  of  it  is  an  epidemic 
in  Central  America,  in  1596,  concerning  which 
Mr.  J.  M.  Keating,  in  his  account  of  the  epidemic 
in  Memphis  in  1878,  speaks  as  follows:2 

The  first  authentic  record  we  have  of  the  appear- 
ance of  yellow  fever  is  that  which  occurred  in  Central 
America,  in  1596.  Subsequently  we  hear  of  it  in  New 
England  among  the  Indians,  in  1618.  After  that  in 
the  Island  of  St.  Lucia,  in  1664,  where  it  killed  over 
1411  out  of  a  population  of  1500  soldiers,  a  ratio  of 
I  in  i. 06  of  the  whole  number.  We  next  hear  of  it 
in  the  same  place,  in  1665,  when,  out  of  500  sailors, 
200  died,  being  i  in  2.5,  and  again  in  1666,  when 
every  man,  woman,  and  child  of  5000  died.  New  York 
was  visited  by  it  for  the  first  time  in  1668;  Boston  in 
1691  and  again  in  1693;  Philadelphia  was  visited  for 
the  first  time  in  1695.  In  1699  it  again  visited  the 
latter  city,  the  mortality  being  220,  which  no  doubt 
was  very  heavy,  as  the  inhabitants  were  few  in  num- 
bers, the  town  being  only  seventeen  years  old.  Charles- 
ton, S.  C.,  was  also  visited  for  the  first  time  in  1699, 
but  what  the  mortality  was  we  hav.e  no  means  of 
knowing. 

Between  the  years  1702  and  1800  yellow  fever 
appeared  in  the  United  States,  according  to  Keat- 
ing, thirty-five  times,  in  localities  varying  from 
Pensacola  to  Nantucket  Island,  but  showing  a 

2  "History  of  the  Yellow  Fever  Epidemic  of  1878,"  J.  M. 
Keating,  1879. 


84      WALTER   REED   AND   YELLOW   FEVER 

marked  preference  for  the  cities  of  the  South. 
Among  these  visitations  was  the  epidemic  in  Phil- 
adelphia in  1793,  when  the  death  rate  was  I  in 
10  of  the  population.  Between  the  years  1800  and 
1879,  when  Keating's  book  was  issued,  yellow  fever 
visited  the  United  States  every  year  with  two  excep- 
tions, although  it  was  epidemic  on  only  a  few 
occasions.  The  great  epidemics  during  this  period 
were  that  of  New  Orleans  in  1853,  in  which  there 
were  29,020  cases  with  8101  deaths,  a  mortality 
of  27.91  per  cent.;  and  that  of  Memphis  in  1878, 
when  there  were  17,600  cases  with  5150  deaths,  a 
mortality  of  i  in  3.3.  In  1878  the  disease  also  raged 
extensively  throughout  the  Southern  States  in  gen- 
eral, reaching  as  far  north  as  Virginia. 

Up  to  the  time  of  the  Philadelphia  epidemic  of 
1793  yellow  fever  seems  to  have  been  accepted 
without  question  as  the  visitation  of  God,  and  no 
theories  in  regard  to  its  origin  or  mode  of  trans- 
mission were  developed.  In  1793,  however,  when 
the  interest  of  the  medical  profession  in  Philadel- 
phia was  focussed  on  the  disease,  two  hypotheses 
as  to  the  manner  in  which  it  originated  were 
brought  forward.  One  of  them  was  that  of  direct 
importation,  probably  from  the  West  Indies,  and 
this  was  supported  by  the  College  of  Physicians. 
The  other  view,  held  by  some  of  the  best  authori- 
ties in  the  city,  and  in  particular  by  Dr.  Benjamin 


HISTORY   OF   YELLOW   FEVER  85 

Rush,  was  that  of  a  local  origin,  that  is  to  say,  of 
spontaneous  generation  under  appropriate  condi- 
tions of  filth,  heat,  and  moisture. 

The  manner  by  which  the  disease  was  propa- 
gated also  became  the  subject  of  discussion,  al- 
though definite  theories  in  regard  to  this  point 
were  slow  to  develop.  In  1793  the  large  ma- 
jority of  physicians  held  that  yellow  fever  was 
transmitted  through  direct  contact  with  the  in- 
fected individual,  although  there  were  a  few  who 
believed  its  extension  was  due  to  the  diffusion, 
through  the  agency  of  the  air,  of  morbid  exhala- 
tions, themselves  the  offspring  of  organic  decom- 
position. The  latter  doctrine  gradually  gained 
ground,  until,  at  last,  the  physicians  of  Philadel- 
phia became  divided  into  two  hostile  parties,  and, 
says  La  Roche,  from  whom  I  quote,  "  From  this 
moment  may  be  dated  the  origin  of  the  intermin- 
able dispute  about  contagion  and  non-contagion 
which  has  continued  ever  since  to  occupy  the  atten- 
tion of  the  medical  profession  in  this  and  in  other 
countries."3 

Priority  in  the  publication  of  views  on  the  non- 
contagion  theory  was  for  many  years  the  subject  of 
much  discussion.  La  Roche  tells  us  that  Dr.  Na- 
thaniel Potter,  of  Baltimore  (died  1843),  in  an 
essay  on  contagion  published  some  time  after  the 
Philadelphia  epidemic,  claims  that  in  October, 
3  "  Yellow  Fever,"  by  R.  La  Roche,  M.  D.,  1855. 


86  WALTER  REED  AND  YELLOW  FEVER 
1793,  he  had  written  to  Dr.  Rush  emphasising  the 
domestic  origin  and  the  non-contagious  character 
of  the  epidemic  diseases  of  the  Eastern  Shore  of 
Maryland,  and  had  then  expressed  the  opinion  that 
fevers  arising  from  vegetable  decomposition  are 
non-contagious,  suggesting  at  the  same  time  that 
the  yellow  fever  epidemic  raging  in  Philadelphia 
was  also,  as  he  expresses  it,  "  devoid  of  that  prop- 
erty." Dr.  Potter  further  states  that  in  the  summer 
of  1795,  believing  that  he  was  at  that  time  the  only 
person  in  America  who  denied  the  contagious  char- 
acter of  the  disease,  and  that  his  opinion  could  be 
sustained  by  facts,  he  proposed  to  embody  his  views 
in  a  thesis,  but  was  dissuaded  from  doing  so  by  Dr. 
Wistar.  This  claim  to  priority  is  explicit,  but  it  is 
sustained  only  by  a  letter,  not  made  public  until 
1818,  and  however  true  it  is  that  Dr.  Potter  enter- 
tained such  views,  his  claim  to  priority  must  yield 
to  that  of  others  who  were  less  tardy  in  making 
their  opinions  public.  Other  claimants  to  the  dis- 
tinction of  first  formulating  the  doctrine  of  non- 
contagion  are  Dr.  Davidge  of  Baltimore,  in  the 
Baltimore  Federal  Gazette  of  November  30,  1797, 
and  Dr.  Charles  MacLean,  an  English  authority, 
who  unhesitatingly  ascribes  the  belief  in  non-con- 
tagion, which  appeared  in  Philadelphia  about 
1798,  to  the  influence  of  a  dissertation  by  himself 
on  the  source  of  epidemic  diseases,  originally 


HISTORY   OF   YELLOW   FEVER  87 

issued  in  Calcutta,  in  1796,  and  reprinted  in  Phila- 
delphia in  1797. 

According  to  La  Roche,  however,  there  can  be 
no  doubt  that  to  Dr.  Jean  Deveze  of  Philadelphia 
belongs  the  distinction  of  first  publicly  enunciat- 
ing the  non-contagion  theory.  Dr.  Deveze  arrived 
in  Philadelphia  from  the  West  Indies  at  the  be- 
ginning of  the  epidemic  of  1793,  and  was  soon 
after  placed  at  the  head  of  a  hospital  opened  at 
Bush  Hill,  where  he  had  ample  means  of  observ- 
ing the  disease.  In  1794,  a  year  before  Dr.  Potter 
proposed  writing  his  thesis,  Dr.  Deveze  published 
a  description  of  the  epidemic  of  1793,  and  in  this 
essay,  which  has  never,  in  the  opinion  of  La  Roche, 
received  the  attention  it  deserves,  he  boldly  pro- 
claims the  non-contagious  character  of  the  disease, 
assigning  facts  analogous  to  those  advanced  by 
subsequent  writers  and  adducing  arguments  simi- 
lar to  theirs.4 

As  the  facts  brought  out  by  the  epidemic  of  1793 
in  Philadelphia  were  gradually  disseminated,  a 
change  became  perceptible  in  the  opinion  of  the 
leading  physicians  there  and  elsewhere  as  to  the 
question  of  contagion.  Dr.  Rush,  who  in  1793  was 

4  "  An  Inquiry  into  and  Observations  upon  the  Causes  and 
Effects  of  the  Epidemic  which  Raged  in  Philadelphia  from  the 
Month  of  August  till  toward  the  Middle  of  December,  I793-" 
By  Jean  Deveze,  Philadelphia,  1794. 


88      WALTER   REED   AND   YELLOW   FEVER 

himself  a  decided  supporter  of  the  contagion  the- 
ory, modified  his  views  in  the  partial  epidemic 
of  1794,  and  some  years  later  published  a  formal 
recantation  of  what  he  had  come  to  consider  an 
error,  stating  that  although  he  was  aware  of  the 
influence  which  changes  in  medical  opinion  have 
upon  a  physician's  reputation,  he  "  should  consider 
as  small  the  total  sacrifice  of  his  own,  could  it  avert 
the  evils  which  are  connected  with  a  belief  in  the 
importation  of  pestilential  diseases,  and  insure  to 
the  world  the  benefits  which  would  necessarily 
flow  from  the  establishment  of  the  doctrines  of 
non-contagion."  In  a  subsequent  part  of  his  work 
he  even  goes  so  far  as  to  beg  forgiveness  from  the 
friends  of  science  and  humanity  if  the  publication 
of  his  opinion  in  favour  of  the  contagion  theory 
had  exercised  any  influence  in  increasing  the  mis- 
ery and  mortality  attendant  upon  the  disease,  add- 
ing that  such  was  the  pain  he  felt  in  recollecting 
that  he  had  entertained  and  propagated  it,  that  "  it 
would  long,  and  perhaps  always,  deprive  him  of 
the  pleasure  he  might  otherwise  have  derived  from 
a  review  of  his  attempts  to  fulfil  the  public  duties 
of  his  situation." 

Contagionists  at  this  period  were  divided,  ac- 
cording to  La  Roche,  into  three  classes:  first,  those 
who  believed  the  disease  to  be  invariably  conta- 
gious, the  power  of  communication  being  more 


HISTORY   OF   YELLOW   FEVER  89 

actively  displayed  in  crowded,  ill-ventilated,  and 
filthy  places;  second,  those  who  believed  the  dis- 
ease was  naturally  endowed  with  contagious  prop- 
erties, but  that  these  required  an  impure  atmos- 
phere for  their  manifestation;  third,  those  who 
considered  that  the  disease  had  not  naturally  any 
contagious  properties  at  all,  but  could  acquire  them 
through  the  influence  of  favourable  conditions, 
such  as  filth  and  bad  air  or  water.  The  third  of 
these  opinions,  namely,  that  the  disease  becomes 
contagious  only  under  unfavourable  conditions, 
was  upheld  by  many  of  the  best  physicians,  includ- 
ing Dr.  Rush,  up  to  the  time  of  his  recantation,  and 
all  old  writings  on  yellow  fever  contain  constant 
references  to  the  effect  of  heat,  moisture,  and 
organic  decomposition  on  the  spread  of  the  disease. 

The  doctrine  of  local  origin  gained  ground  at 
the  same  time  as  that  of  non-contagion;  indeed, 
there  seems  to  have  been  a  general  impression  that 
direct  importation  implied  contagion,  while  non- 
contagion  assumed  a  local  origin. 

As  would  naturally  be  expected,  the  occurrence 
of  each  epidemic  by  which  some  region  of  the 
country  was  swept  stimulated  men's  minds  to  inves- 
tigation of  the  problems  involved  in  the  disease, 
and,  accordingly,  we  find  epochs  in  the  develop- 
ment of  knowledge  regarding  it  associated  with  the 
years  marked  by  its  most  formidable  outbreaks. 


90     WALTER  REED  AND  YELLOW   FEVER 

With  the  Philadelphia  epidemic  of  1793  the  non- 
contagion  theory,  as  we  have  seen,  found  entrance, 
and  the  years  immediately  following  it  were  fruit- 
ful in  contributions  to  the  support  of  that  view. 

In  1819  a  mild  epidemic  of  yellow  fever  oc- 
curred in  Baltimore,  and  we  then  find  one  of  the 
citizens,  consulted  on  the  subject,  writing  to  the 
mayor  that: 

The  very  fact  that  individuals  every  way  competent 
to  judge  of  the  matter  are  now  found  opposing  the 
doctrine  of  contagion  is  in  itself  evidence  of  such  high 
authority  that  nothing  short  of  so  overwhelming  a 
truth  could  have  removed  their  prejudices  and  changed 
their  opinions.  .  .  .  Of  the  hundreds  and  thou- 
sands who  declare  and  believe  yellow  fever  to  be  a 
contagious  disease  very  few  have  ever  seen  it;  and 
those  who  have  ventured  to  look  upon  it  came  to  the 
sight  with  all  the  horrors  which  must  be  felt  in  the 
field  of  battle,  expecting  every  moment  a  shaft  of  con- 
tagion to  transfix  their  liver;  of  course  they  were  badly 
qualified  to  make  a  cool,  dispassionate  inquiry,  whilst 
our  distinguished  non-contagionists  have  had  rational 
cause  to  triumph  over  all  their  terrors  and  think  like 
men.5 

TKe  opinions  which  are  quoted  in  this  and  other 
letters  show  that  while  the  doctrine  of  contagion 
was  still  accepted  by  the  uneducated  and  preju- 

6  Series  of  Letters  and  Other  Documents  Relating  to  the  Late 
Epidemic  of  Yellow  Fever.  Baltimore,  Second  Dispensary,  1820. 


HISTORY   OF   YELLOW   FEVER  91 

diced,  it  was  generally  discredited  among  those 
carrying  authority. 

In  1853  occurred  the  great  epidemic  in  New 
Orleans,  and  two  years  later,  in  1855,  La  Roche 
published  his  monumental  work  on  the  history  of 
yellow  fever,  which  up  to  the  present  time  has  been 
the  great  authority  on  the  subject  and  will  always 
remain  the  most  complete  source  of  information 
as  to  it  in  the  past.  La  Roche  reviews  all  the 
ground  covered  by  investigation  from  the  time 
when  the  cause  and  propagation  of  yellow  fever 
were  first  under  discussion,  and  sums  up  the  evi- 
dence in  favor  of  local  origin  and  non-contagion. 

A  few  years  later  the  pendulum  had  begun  to 
incline  to  the  other  side.  In  1867  some  mild  epi- 
demics at  New  Orleans,  Galveston,  and  Indianola 
induced  the  United  States  Government  to  send  a 
commission  to  inquire  into  their  cause  and  charac- 
ter. The  official  report  of  this  commission  states 
that  the  direct  importation  of  the  disease  is,  in  its 
opinion,  fully  established,  the  source,  in  that 
particular  instance,  being  Vera  Cruz,  Mexico,  and 
Havana.  The  question  of  contagion  is  not  dis- 
cussed, being  apparently  accepted  as  a  matter  of 
course. 

In  1878  occurred  the  great  epidemic  of  Mem- 
phis, which  belongs  to  the  experience  of  the  present 
generation;  and  in  the  next  year  an  eye-witness, 


92     WALTER   REED   AND   YELLOW   FEVER 

Mr.  J.  M.  Keating,  published  the  vivid  and  inter- 
esting account  of  it  already  mentioned,  which  con- 
tains a  discussion  of  all  the  knowledge  acquired  in 
regard  to  the  disease  up  to  that  date.  He  gives  a 
number  of  different  theories  which  had  been  ad- 
vanced during  the  years  immediately  preceding 
his  work,  some  of  which  are  very  ingenious,  not  to 
say  fantastic. 

Dr.  J.  M.  Clements,  of  Louisville,  attributed  the 
yellow  fever  poison  to  some  order  of  fungus  plants 
indigenous  to  the  tropics,  but  as  yet  undiscovered. 
Dr.  Ford,  of  St.  Louis,  believed  in  a  principle  of 
fermentation,  by  which  yellow  fever  remained 
existent  in  the  form  of  dry  particles  of  dust  every- 
where that  it  had  once  prevailed;  cold,  however, 
repressed  the  activity  of  these  germs,  in  so  far  as 
cold  rendered  persons  less  receptive  and  prevented 
their  bodies  from  being  in  a  condition  to  induce 
the  fermentation  of  the  dry  dust.  Professor  P. 
Stille,  of  Mobile,  advanced  a  novel  theory  which 
attributed  the  disease  to  the  influence  of  the  Gulf 
Stream.  Dr.  Labadie  favoured  the  "  explosive  the- 
ory," namely,  the  theory  that  the  disease  was  caused 
by  a  peculiar  subtle  poison  which  exploded  in  the 
air  like  an  inflammable  substance,  and  that  per- 
sons who  inhaled  or  swallowed  it,  in  greater  or  less 
quantity,  fell  under  its  influence  after  a  certain 
time.  Dr.  Warren  Stone,  of  New  Orleans,  in  com- 


HISTORY   OF   YELLOW   FEVER  93 

pany  with  many  others,  upheld  the  wave,  or  cycle 
theory. 

The  best  authorities,  however,  seem  to  have  in- 
clined to  the  opinion  that  the  disease  was  due  to  a 
specific  germ,  a  view  expressed  in  a  somewhat 
indefinite  manner  by  the  medical  experts  appointed 
by  Congress  in  December,  1878,  to  investigate  the 
disease.  In  their  report  they  state  that: 

It  (yellow  fever)  is  a  specific  disease  produced  by 
the  introduction  into  the  human  organism  of  a  specific 
poison,  and  though  this  specific  poison  has  never  been 
chemically  or  microscopically  demonstrated,  nor  in  any 
way  made  evident  to  the  human  senses,  we  deem  it  safe 
to  assume  that  it  is  material  and  particular,  is  endowed 
with  ordinary  properties,  and  is  subject  to  the  ordinary 
laws  of  material  substance.  We  also  hold  that  it  is  or- 
ganic— is  endowed  with  the  vital  properties  of  growth 
and  reproduction;  that  it  is  not  malarial,  but  the  con- 
currence of  local  conditions  favourable  to  the  evolu- 
tion of  it  seems  to  be  necessary  to  the  evolution  of 
yellow  fever  epidemics. 

It  is  about  this  time  that  fomites,  a  term  which 
for  the  next  twenty  years  did  constant  service, 
begins  to  come  into  prominence.  Dr.  L.  S.  Tracy, 
in  a  number  of  the  Popular  Science  Monthly  about 

1878, says: 

Yellow  fever  occupies  a  singular  position  between 
the  contagious  and  non-contagious  diseases.  The  poi- 


94      WALTER   REED   AND   YELLOW   FEVER 

son  is  not  like  that  of  smallpox,  directly  communica- 
ble from  a  sick  person  to  a  well  one;  but,  although 
the  emanations  of  the  sick  are  connected  with  the 
spread  of  the  disease,  they  seem  to  require  an  appro- 
priate nidus  in  which  to  germinate  and  develop.  This 
nidus  must  be  warm  and  moist,  and  there  the  germs, 
whatever  they  are,  lie  and  grow,  or  in  some  way  de- 
velop until  they  are  able  to  migrate.  The  germs  are 
portable  and  may  be  conveyed  in  baggage  or  merchan- 
dise (fomites)  for  hundreds  or  thousands  of  miles.  If 
not  so  conveyed  the  spread  of  the  disease  is  very  slow. 
In  1822,  in  New  York,  when  it  gained  a  foothold  in 
Rector  Street,  it  appeared  to  travel  about  40  feet  a 
day  until  killed  by  the  frost.  It  often  leaves  a  house 
or  a  block  intact,  going  round  it  and  attacking  those 
beyond  with  no  assignable  reason.  A  thin  board  parti- 
tion seems  to  have  stopped  it  on  Governor's  Island,  in 
1856,  and  an  instance  is  related  where  it  attacked  the 
sailors  in  all  the  berths  of  one  side  of  a  ship  before 
crossing  to  the  other.  Such  apparent  vagaries,  in  the 
present  state  of  our  knowledge,  are  inexplicable. 

From  all  these  data  it  would  appear  that  knowl- 
edge of  yellow  fever  had  at  this  period  advanced 
very  little  beyond  its  status  in  1793,  if,  indeed,  it 
had  not  in  some  respects  receded;  for,  although 
the  contagion  theory  in  its  original  sense  was  aban- 
doned, that  is  to  say,  the  direct  transmission  of  the 
disease  from  one  person  to  another,  after  the  fash- 
ion of  smallpox  and  other  eruptive  fevers,  was  no 


HISTORY    OF   YELLOW   FEVER  95 

longer  accepted,  the  theory  of  its  conveyance  by 
means  of  fomites  was  now  fully  established. 

For  twenty  years  after  this,  knowledge  of  yellow 
fever  remained  stationary,  and,  in  1898,  the  offi- 
cers of  the  United  States  Marine  Hospital  Service 
issued  a  report  in  which  they  sum  up  the  status  of 
knowledge  at  that  period  as  follows : 

While  yellow-fever  is  a  communicable  disease,  it  is 
not  contagious  in  the  ordinary  acceptation  of  the  term, 
but  is  spread  by  the  infection  of  places  and  articles  of 
bedding,  clothing,  and  furniture.  This  is  a  process  re- 
quiring several  days  (extrinsic  infection),  and  during 
this  period  the  yellow  fever  patient  is  as  harmless  as 
one  suffering  from  a  surgical  complaint.  .  .  .  More 
recently  the  idea  has  been  advanced  that  probably  the 
germ  of  yellow  fever  enters  the  general  circulation 
through  the  respiratory  organs  in  some  obscure  man- 
ner, and  incubating  in  the  blood  directly  poisons  this 
life-giving  stream.  However  this  may  be,  the  present 
opinion  is  that  one  has  not  to  contend  with  an  organism 
or  germ  which  may  be  taken  into  the  body  with  food 
or  drink,  but  with  an  almost  inexplicable  poison  so 
insidious  in  its  approach  and  entrance  that  no  trace  is 
left  behind. 

This  is  practically  the  last  official  statement  un- 
der the  old  order  and  the  last  defence  of  the  old- 
fashioned  theories  on  yellow  fever. 


CHAPTER   V, 

INSECTS   AND   DISEASE 

"  Imo  muscas 

turn  infirmorum  turn  cadaverum  succo  saturatas,  mox  in  alias 
domos  vicinas  transmigrantes  dum  sordibus  suis  comestibilia  in- 
ficiunt  hominibus  iis  vescentibus  contagium  attulisse  Mercuri- 
alis  refert." — ATHANASIUS  KIRCHER,  Scrutinium  Physico- 
Medicum,  etc.,  1659,  p.  247. 

EXPERIMENTAL  evidence  proving  that  insects 
play  an  important  part  in  the  transmission  of  dis- 
ease is  of  recent  date,  but  suggestions  to  that  effect 
are  found  scattered  through  literature  for  a  num- 
ber of  years.  Indeed,  the  early  history  of  almost 
every  infectious  or  contagious  disease  contains  some 
reference  to  its  supposed  transmission  by  means  of 
flies  or  other  insects.  Anthrax,  cholera,  typhoid 
fever,  malaria,  tuberculosis,  leprosy,  the  plague, 
yellow  fever,  and  many  other  less  well-known  dis- 
eases have  been  associated  by  early  writers  with 
insects  as  a  mode  of  transmission.  Anyone  inter- 
ested in  the  subject  will  find  it  exhaustively  treated 
in  Nuttall's  monograph  in  the  Johns  Hopkins  Hos- 
pital Reports  for  1899.* 

1  "  On  the  role  of  insects,  arachnids,  and  myriapods,  as  car- 
riers in  the  spread  of  bacterial  and  parasitic  diseases  of  man  and 


INSECTS   AND   DISEASE  97 

The  earliest  of  all  allusions,  so  far  as  I  can  dis- 
cover, is  found  in  a  treatise  called  " De  Regimine 
Pestilentico"  which  appeared  in  1498,  and  is 
attributed  to  Bishop  Knud  of  Aarhus,  Denmark. 
Athanasius  Kircher,  a  learned  priest  and  naturalist 
of  the  seventeenth  century,  went  farther,  perhaps, 
than  anyone  towards  a  clear  understanding  of  the 
part  played  by  insects  as  carriers  of  disease.  In 
his  interesting  work,  " Scrutinium  Physico-Med- 
icum"  etc.,  published  at  Rome  in  1659,  he  says: 
"  Flies  carry  the  plague,"  and  again,  "  There  can 
be  no  doubt  that  flies  feed  on  the  internal  secre- 
tions of  the  diseased  and  dying,  then  flying  away, 
they  deposit  their  excretions  on  the  food  in  neigh- 
bouring dwellings,  and  persons  who  eat  it  are  thus 
infected." 

Ambroise  Pare,  in  his  description  of  the  battle- 
field of  St.  Quentin  in  1557,  strikes  the  same  note 
when  he  says : 2  "  We  saw  more  than  half  a  league 
round  us  the  earth  all  covered  with  the  dead ;  and 
hardly  stopped  there,  because  of  the  stench  of  the 
dead  men  and  their  horses;  and  so  many  blue  and 
green  flies  rose  up  from  them,  bred  of  the  moisture 
of  their  bodies  and  the  heat  of  the  sun,  that  when 

animals."  A  critical  and  historical  study,  by  G.  H.  F.  Nuttall, 
M.  D.,  Ph.  D.,  Johns  Hopkins  Hosp.  Rep.,  1899,  vol.  VIII., 
p.  i. 

2  "  Ambroise  Pare  and  his  Times,"  by  Stephen  Paget,  1897. 


98     WALTER   REED   AND  YELLOW   FEVER 

they  were  up  in  the  air  they  hid  the  sun.  It  was 
wonderful  to  hear  them  buzzing;  and  where  they 
settled,  there  they  infected  the  air,  and  brought  the 
plague  with  them";  and  he  adds,  quaintly:  "  Mon 
petit  maistre,  I  wish  you  had  been  with  me,  to  ex- 
perience the  smells  and  make  report  thereof  to 
them  that  were  not  there." 

The  first  person  to  establish  the  fact  that  insects 
act  as  carriers  of  disease  on  a  scientific  basis  was 
Dr.,  now  Sir,  Patrick  Manson,  in  1880.  He  demon- 
strated that  the  mosquito  acts  as  the  intermediary 
host  of  the  Filaria  Sanguinis  Hominis,  and  is  thus 
directly  instrumental  in  the  production  of  chyluria, 
elephantiasis,  lymph-scrotum,  etc.  Manson's  de- 
scription of  the  part  played  by  the  mosquito  under 
these  circumstances  is  as  follows : 8 

Should  a  certain  species  of  mosquito  which  has  fed 
on  the  blood  of  a  filaria-infested  individual  be  exam- 
ined immediately  after  feeding,  the  blood  contained  in 
the  stomach  of  the  insect  will  be  found  to  contain 
large  numbers  of  living  filariae.  If  a  second  mosquito 
be  examined  three  or  four  hours  after  it  has  similarly 
fed,  it  will  be  found  that  the  blood  corpuscles  in  its 
distended  abdomen  have,  in  great  measure,  parted 
with  the  haemoglobin  and  that  the  blood  plasma  has 
become  thickened,  though  not  coagulated.  If  attention 
be  directed  to  the  filariae  in  the  thickened  blood,  it  will 

3  "  Tropical  Diseases.  A  Manual  of  the  Diseases  of  Warm 
Climates,"  1898. 


INSECTS   AND   DISEASE  99 

be  seen  that  many  of  them  are  actively  engaged  in  en- 
deavouring to  escape  from  their  sheaths.  The  diffused 
haemoglobin  has  so  thickened  the  blood  plasma  that  it 
has  become  viscid  and  holds,  as  it  were,  the  sheath. 
This  viscosity  of  the  blood  seems  to  prompt  the  filariae 
to  endeavour  to  escape  from  their  sheaths.  They  be- 
come restless  and  excited,  alternately  retiring  toward 
the  tail,  and  then  rushing  forward  against  the  head  end 
of  the  sheath  in  frantic  efforts  to  escape.  After  a  time 
the  majority  succeed  in  effecting  a  breach,  and  in  wrig- 
gling themselves  free  from  the  sheaths  which  had 
hitherto  enclosed  them.  The  filariae  now  swim  free  in 
the  blood  and  the  character  of  their  movements  once 
more  undergoes  a  remarkable  change.  Hitherto,  though 
active  enough  in  wriggling  about,  the  parasite  did  not 
materially  change  its  position  on  the  slide,  but  now,  hav- 
ing become  free,  it  moves  about  from  place  to  place — 
locomotes — in  fact.  If  we  dissect  a  mosquito  at  a 
somewhat  later  period  after  feeding,  it  will  be  found 
that  the  stomach  of  the  insect,  though  still  full  of 
blood,  contains  very  few  filariae,  although  their  empty 
sheaths  can  be  seen  in  abundance.  If,  however,  we 
break  up  with  needles  the  thorax  of  the  insect  and 
tease  out  the  muscular  tissue,  we  shall  find  that  the 
filarias  after  discarding  their  sheaths  have  quitted  the 
stomach  and  entered  the  thoracic  muscles  of  the  insect, 
among  which  they  can  now  be  seen,  moving  languidly. 
By  a  course  of  serial  dissections  of  filariated  mosqui- 
toes, we  can  ascertain  that  in  the  thorax  of  the  insect 
the  parasite  enters  upon  a  metamorphosis  which  takes 
from  six  to  seven  days  to  complete — a  metamorphosis 
eventuating  in  the  formation  of  a  mouth,  of  an  ali- 
mentary canal,  and  of  a  peculiar  trilobed  tail,  as  well 


ioo     WALTER   REED  AND   YELLOW   FEVER 

as  in  an  enormous  increase  in  the  size  and  activity  of 
the  young  parasite. 

About  a  week  after  the  time  of  feeding,  the  mos- 
quito, in  the  ordinary  course  of  nature,  lays  her  eggs 
on  the  surface  of  stagnant  water,  and  thereafter  dies, 
falling  into  the  water.  It  is  conjectured  that  the  filaria, 
now  a  formidable-looking  and  a  very  active  animal, 
about  one-sixteenth  of  an  inch  in  length,  escapes  from 
the  dead  body  of  the  insect,  and  thus,  in  drinking  water, 
it  obtains  a  chance  of  gaining  access  to  the  stomach  of  a 
human  host.  It  is  believed  that  it  bores  its  way  through 
the  wall  of  the  stomach,  through  the  intervening  tissues, 
and  finally  enters  the  lymphatic  trunks.  Arrived  in  one 
of  these,  it  attains  sexual  maturity,  fecundation  is 
effected,  and  in  due  course  of  time  new  generations  of 
embryo  filarias  are  poured  into  the  lymph.  These, 
passing  through  the  glands — if  such  intervene — by  way 
of  the  thoracic  duct  and  left  sub-clavian  vein,  or  by  the 
lymphatics  of  the  upper  part  of  the  body,  appear  in 
the  circulation.  Such  is  the  life-history  of  filaria  noc- 
turna;  man  is  its  definitive  host,  the  mosquito  its  interme- 
diate host.  It  is  manifest  that  filarial  periodicity  is  an 
adaptation  of  the  habits  of  the  mosquito  parasite  to 
that  of  the  mosquito. 

These  conclusions  of  Manson's  were  subsequently 
confirmed  by  the  experiments  of  Dr.  Bancroft,  in 
Australia,  and  of  Dr.  J.  R.  Lewis,  in  India,  as  well 
as  those  of  Dr.  Sonsino,  in  Egypt. 

In  1883  an  admirable  paper  by  Dr.  A.  F.  A. 
King  on  "  Insects  and  Disease — Mosquitoes  and 
Malaria,"  appeared  in  the  Popular  Science 


INSECTS   AND  DISEASE  101 

Monthly  for  September  of  that  year.  The  object 
of  this  paper,  it  is  stated,  is  "  to  present  a  series  of 
facts  with  regard  to  the  so-called  malarial  poison, 
and  to  show  how  they  may  be  explicable  by  the 
supposition  that  the  mosquito  is  the  real  source  of 
diseases,  rather  than  the  inhalation  or  cutaneous  ab- 
sorption of  a  marsh  vapour."  The  facts  presented 
by  Dr.  King  are  evidently  the  result  of  close  obser- 
vation and  able  reasoning,  and  they  show  an  exten- 
sive acquaintance  with  the  literature  of  the  subject. 
He  had  no  experimental  evidence  to  adduce  in 
support  of  his  theory,  but  he  handles  his  hypotheti- 
cal material  in  a  masterly  manner,  and  offers  a 
stable  foundation  for  further  investigation.  He 
shows  that  the  distribution,  spread,  and  general 
characteristics  of  malaria  all  correspond  with  the 
life-history  of  the  mosquito;  also  that  mosquitoes 
are  common  wherever  malaria  is  prevalent;  and 
the  conclusions  he  draws  as  to  the  possibility  of 
protection  from  malaria  by  destruction  of  mos- 
quitoes are  just  what  subsequent  experiments  have 
demonstrated  to  be  true.  His  own  words  are: 
"  While  the  data  to  be  presented  cannot  be  held 
to  prove  the  theory,  they  may  go  so  far  as  to  initiate 
and  encourage  experiments  and  observations  by 
which  the  truth  or  fallacy  of  the  views  now  held 
may  be  demonstrated." 

Further  suggestions  on  the  subject  were  made  by 


104     WALTER   REED   AND   YELLOW   FEVER 

several  observers,  the  most  important  of  them  being 
Koch,  in  1884,  and  Laveran  (independently),  in 
the  same  year.  It  is,  however,  first  to  Dr.  Manson 
and  then  to  Major  Ronald  Ross  of  the  British 
Army  that  we  are  indebted  for  a  clear  and  definite 
knowledge  of  the  part  played  by  mosquitoes  in  the 
transmission  of  malaria. 

»  The  fact  that  the  red  blood  corpuscles  of  verte- 
brates may  contain  within  them  certain  parasites 
had  been  known  for  some  time.  These  parasites 
are  divided  into  three  groups,  one  of  which  is  found 
in  reptiles,  another  in  oxen  (being  the  cause  of 
Texas  fever) ,  and  a  third,  which  has  received  the 
name  of  hamamcebidcB,  in  man.  This  third  group 
includes  the  parasite  of  malarial  fever,  which 
exists  under  three  varieties,  corresponding  to  the 
three  forms  of  the  disease,  tertian,  quartan,  and 
remittent.  All  the  species  have  a  close  resemblance 
to  each  other  and  all  contain  the  typical  melanin 
of  malarial  fever.  The  youngest  parasites  are 
found  as  minute  amcebula,  living  within  the  red 
blood  corpuscle,  and  generally  containing  granules 
of  this  melanin  derived  from  the  haemoglobin  of 
the  corpuscle.  When  these  amcebulce  reach  ma- 
turity they  reproduce  themselves  in  the  ordinary 
asexual  manner  by  means  of  spores,  but  they  also, 
at  one  time  in  their  life-history,  undergo  sexual 
reproduction  through  the  formation  of  gameto- 


INSECTS   AND  DISEASE  103 

cytes,  and  it  is  in  the  life-history  of  these  gameto- 
cytes  that  the  solution  of  the  malarial  problem  lies. 
Long  before  Manson's  time  they  were  observed  to 
circulate  in  the  blood  of  their  hosts  without,  appar- 
ently, performing  any  function  whatever.  As  soon, 
however,  as  they  are  withdrawn  from  the  circula- 
tion they  are  seen  to  swell  up  and  liberate  them- 
selves from  the  enclosing  capsule,  after  which  some 
of  them  emit  a  number  of  long  motile  filaments. 
These  filaments  can  then  be  seen  to  struggle  wildly 
and  sometimes  to  break  from  the  parent  cell,  dart- 
ing away  among  the  corpuscles  and  leaving  the 
residue  of  the  gametocyte,  with  its  melanin,  an 
inert  mass.  A  hot  controversy  concerning  the  na- 
ture of  this  phenomenon  had  been  in  existence  ever 
since  it  was  discovered.  Laveran,  who  first  ob- 
served it,  considered  that  the  motile  filaments  are 
living  organs  and  constitute  a  stage  in  the  life-his- 
tory of  the  parasite.  Bignami,  and  others  of  the 
Italian  school,  held  to  the  old  theory  that  it  is  a 
retrogressive  phenomenon,  a  distinct  disintegration 
of  the  parasite  due  to  its  death  in  vitro.  At  this 
point  the  controversy  rested  for  a  time,  except  that 
Laveran  and  his  followers  thought  that  the  motile 
filaments  were  meant  to  lead  a  saprophytic  exist- 
ence, but  they  did  not  offer  any  explanation  as  to 
how  they  could  escape  from  the  body  in  order  to 
do  so. 


104     WALTER  REED  AND  YELLOW   FEVER 

Manson  accepted  the  view  that  the  gametocytes 
are  living  organisms,  and  he  considered  that  the 
fact  of  their  appearance  only  after  the  abstraction 
of  the  blood  must  have  some  definite  purpose  in 
the  life  scheme  of  the  parasite.  What  this  purpose 
was  he  set  himself  to  discover. 

He  had  already  pushed  the  method  of  inductive 
reasoning  to  a  brilliantly  successful  issue  in  his  dis- 
covery of  the  development  of  the  filaria  nocturna 
within  the  body  of  the  mosquito,  and  he  pursued 
the  same  plan  here.  It  is,  of  course,  evident  that 
the  malarial  parasite,  like  all  others,  must  pass 
from  host  to  host,  since  all  known  parasites  are 
capable  not  only  of  entering  the  host,  but  of  leaving 
him,  either  themselves  or  by  their  progeny.  Here, 
in  Manson's  opinion,  lay  the  explanation  of  the 
fact  that  the  motile  filaments  appear  only  after 
abstraction  of  the  blood.  The  phenomenon,  though 
usually  observed  in  a  preparation  for  the  micro- 
scope, is  really  meant  to  occur  within  the  stomach 
cavity  of  some  suctorial  insect,  and  constitutes  the 
first  step  in  the  life-history  of  the  parasite  outside 
the  vertebrate  host.  Supposing  this  to  be  the  case, 
the  connection  between  malarial  fever  and  low- 
lying  areas  in  warm  countries  suggested  that  the 
suctorial  insect  must  be  the  mosquito.  This  view 
proved  to  be  correct,  although  Manson's  first  idea 
that  the  motile  filaments  are  spores  which  es- 


INSECTS   AND  DISEASE  105 

cape  from  the  gametocytes  in  the  stomach  cavity 
of  the  mosquito  and  then  occupy  and  infest  the  tis- 
sues of  the  insect  was  afterwards  disproved  by  the 
experiments  of  W.  G.  MacCallum. 

MacCallum  showed  that  the  motile  filaments 
were  not  spores,  but  micro  gametes,  i.  e.,  bodies  of 
the  nature  of  spermatozoa.  As  soon  as  the  gameto- 
cytes, which  are  sexual  cells,  male  and  female,  are 
ingested  by  a  suctorial  insect  they  begin  their 
proper  functions :  the  male  gametocyte  emits  a  var- 
iable number  of  micro  gametes  (the  motile  fila- 
ments), which  wander  to  and  fro  in  search  of  the 
female  gametocytes.  The  female  contains  a  single 
macrogamete,  or  ovum,  which  is  fertilised  by  one 
of  the  microgametes,  and  becomes  a  zygote.  As 
soon  as  this  discovery  of  MacCallum's  was  an- 
nounced, Manson  saw  the  importance  of  its  bearing 
on  the  mosquito  theory,  for  if  the  motile  filaments 
did  not  infect  the  insect,  it  was  probably  the  func- 
tion of  the  zygote  to  do  so,  and  this  view  proved 
correct,  although  it  was  some  time  before  it  was 
established. 

Towards  the  end  of  the  year  1894  Manson  com- 
municated his  theory  concerning  the  mosquito  to 
Major  Ronald  Ross,  who  at  once  set  himself  to 
investigate  it  in  the  malarial  districts  in  India, 
where  he  was  then  stationed. 


106     WALTER   REED   AND   YELLOW   FEVER 

The  task  so  lightly  commenced  [Ross  says],  was, 
as  a  matter  of  fact,  one  of  so  arduous  a  nature  that 
we  must  attribute  its  accomplishment  largely  to  good 
fortune.  The  method  adopted — the  only  method  which 
could  be  adopted — was  to  feed  gnats4  (mosquitoes) 
of  various  species  on  persons  whose  blood  contained 
the  gametocytes,  and  then  to  examine  the  insects  care- 
fully for  the  parasites  which  by  hypothesis  the  gameto- 
cytes  were  expected  to  develop  into.  This  required  not 
only  familiarity  with  the  histology  of  gnats,  but  a 
laborious  search  throughout  the  whole  tissues  of  each 
individual  insect  examined — a  work  of  at  least  two  or 
three  hours  for  each  individual,  but  the  serial  labour 
involved  was  the  smallest  part  of  the  difficulty.  Both 
the  form  and  appearance  of  the  object  I  was  in  search 
of,  and  the  species  of  gnat  in  which  I  might  expect  to 
find  it,  were  absolutely  unknown  quantities.  We  could 
make  no  attempt  to  predict  the  appearance  which  the 
parasite  would  assume  in  the  gnat;  while,  owing  to 
the  general  distribution  of  malarial  fever  in  India,  thf 
species  of  insect  engaged  in  the  propagation  of  the 
disease  could  scarcely  be  determined  by  a  comparison 
of  the  prevalence  of  different  kinds  of  gnats  at  different 
spots  with  the  prevalence  of  the  fever  at  those  spots. 
In  short,  I  was  obliged  to  rely  simply  on  the  careful 
examination  of  hundreds  of  gnats,  first  of  one  specie* 
and  then  of  another,  all  fed  on  patients  suffering  frona 
malarial  fever — in  the  hope  of  one  day  finding  the  clue 
I  was  in  search  of.  Needless  to  say  that  nothing  but 
the  most  convincing  theory,  such  as  Manson's  theory 

4  Major  Ross  uses  the  word  "  gnat "  for  mosquito  through- 
out the  article. 


INSECTS   AND  DISEASE  107 

was,  would  have  supported  or  justified  so  difficult  an 
enterprise.5 

For  nearly  two  years  and  a  half  the  search  was 
almost  entirely  negative,  and  Major  Ross  had  be- 
gun to  despair,  when  fortune  unexpectedly  placed 
the  clue  in  his  hands.  In  a  bottleful  of  larvae, 
brought  by  a  native  from  an  unknown  source,  there 
were  a  number  of  newly  hatched  mosquitoes,  be- 
longing to  a  species  with  spotted  wings  and  boat- 
shaped  eggs,  which  Major  Ross  had  only  recently 
observed  and  of  which  he  did  not  know  the  name. 
Eight  of  these  mosquitoes  were  fed  on  a  patient 
whose  blood  contained  "  crescentic  gametocytes  " 
and  then  examined;  six  of  them  were  dissected 
prematurely,  but  the  seventh  when  examined  cell 
by  cell  gave  the  following  results : 

The  tissues  of  the  stomach  (which  was  now  empty 
owing  to  the  meal  of  malarial  blood  taken  by  the 
insect  four  days  previously  being  digested)  were  re- 
served to  the  last.  On  turning  to  this  organ  I  was 
struck  by  observing,  scattered  on  its  outer  surface,  cer- 
tain oval  or  round  cells  of  about  two  to  three  times  the 
diameter  of  a  red  blood  corpuscle — cells  which  I  had 
never  before  seen  in  any  of  the  hundreds  of  mosquitoes 
examined  by  me.  My  surprise  was  complete  when  I 
next  detected  within  each  of  these  cells  a  few  granules 
of  the  characteristic  coal-black  melanin  of  malarial 

5  "  Malaria  and  Mosquitoes."    Nature,  1900,  vol.  61,  p.  522. 


io8     WALTER   REED   AND   YELLOW   FEVER 

fever — a  substance  quite  unlike  anything  usually  found 
in  mosquitoes.  Next  day  the  last  of  the  remaining 
spotted-winged  insects  was  dissected.  It  contained  pre- 
cisely similar  cells,  each  of  which  possessed  the  same 
melanin;  only  the  cells  in  the  second  mosquito  were 

somewhat  larger  than  those  In  the  first 

These  fortunate  observations  solved  the  malarial 
problem.  As  a  matter  of  fact  the  cells  were  the 
zygotes  of  the  parasite  of  remittent  fever  growing 
in  the  tissues  of  the  gnat;  and  the  gnat  with  spot- 
ted wings  and  boat-shaped  eggs  in  which  I  found 
them  belonged  (as  I  subsequently  ascertained)  to  the 
genus  anopheles.  Of  course  it  was  impossible  abso- 
lutely to  prove  at  the  time,  on  the  strength  of  these 
two  observations  alone,  that  the  cells  found  by  me  in 
the  gnats  were  indeed  derived  from  hamamcebida 
sucked  up  by  the  insects  in  the  blood  of  the  patients  on 
whom  they  had  fed; — this  proof  was  obtained  by  sub- 
sequent investigations  of  mine;  but  .  .  .  the  clue 
was  obtained:  it  was  necessary  only  to  follow  It  up — 
an  easy  matter. 

The  further  experiments  by  means  of  which 
Major  Ross  established  beyond  any  possibility  of 
doubt  that  the  cells  containing  the  melanin  of 
malaria  are  really  zygotes  will  be  found  in  the 
interesting  article  upon  which  I  have  already  made 
such  liberal  demands.  I  must  confine  myself  to 
abstracting  from  it  a  brief  account  of  the  life- 
history  of  the  zygotes. 

After  fertilisation  of  the  macrogamete  has  taken 


INSECTS   AND  DISEASE  109 

place  in  the  stomach  cavity  of  the  gnat,  the  ferti- 
lised parasite,  or  zygote,  has  the  power  of  working 
its  way  through  the  mass  of  blood  contained  in  the 
stomach,  of  penetrating  the  wall  of  the  organ,  and 
of  affixing  itself  on,  or  just  under,  its  outer  coat. 
Here  it  first  appears  about  thirty-six  hours  after 
the  insect  is  fed,  as  a  "  pigmented  cell,"  that  is,  a 
little  oval  body  about  the  size  of  a  large  red  cor- 
puscle, which  contains  the  granules  of  melanin  pos- 
sessed by  the  parent  gametocyte  from  which  the 
macrogamete  originally  came.  In  this  position  it 
shows  no  sign  of  movement,  but  begins  to  grow  rap- 
idly, to  acquire  a  thickened  capsule,  and  to  project 
from  the  outer  wall  of  the  stomach  to  which  it  is 
attached  into  the  body  cavity  of  the  insect  host.  At 
the  end  of  six  days,  if  the  temperature  of  the  body 
be  sufficiently  high  (about  80°  F.) ,  the  diameter  of 
the  zygote  has  increased  to  about  eight  times  what 
it  was  at  first.  If  the  stomach  of  an  infected  insect 
be  extracted  at  this  stage  it  can  be  seen  by  a  low 
power  of  the  microscope  to  be  studded  with  a  num- 
ber of  attached  spheres,  which  have  something  the 
appearance  of  warts  on  a  finger.  These  are  the 
large  zygotes,  which  have  now  reached  maturity. 
Every  zygote  now,  as  it  increases  in  size,  divides 
into  meres,  each  of  which  next  becomes  a  blasto- 
phore,  carrying  a  number  of  blasts  attached  to  its 
surface.  Finally,  the  blastophore  vanishes,  leav- 


i  io     WALTER   REED   AND  YELLOW   FEVER 

ing  the  thick  capsule  of  the  zygote  packed  with 
thousands  of  blasts.  The  capsule  then  ruptures  and 
allows  the  blasts  to  escape  into  the  body  fluids  of 
the  insect. 

The  question  of  importance  which  now  arises  is : 
How  do  the  blasts  which  are  the  spores,  and  there- 
fore the  progeny  of  the  zygotes,  carry  on  the  life- 
history  of  the  parasite  to  a  further  stage?  What  is 
their  function?  It  is  evident  that  a  knowledge  of 
the  mode  of  infection  in  malarial  fever  depends  on 
the  answer  to  this  question.  The  zygotes,  as  has 
been  said,  become  ripe  and  rupture,  scattering  the 
blasts  into  the  body  cavity  of  the  insect.  Then,  by 
some  process,  apparently  owing  to  the  circulation 
of  the  fluids  of  the  insect's  body,  the  blasts  find  their 
way  into  every  part  of  the  mosquito. 

Beyond  this  it  was  difficult  to  go,  but  at  last,  after 
examining  the  head  and  thorax  of '  one  insect,  I 
found  a  large  gland  consisting  of  a  central  duct  sur- 
rounded by  large  grape-like  cells.  My  astonishment 
was  great  when  I  found  that  many  of  these  cells 
were  closely  packed  with  the  blasts,  which  are  not  in 
the  least  like  any  normal  structure  found  in  the  mos- 
quito. Now  I  did  not,  at  this  time,  know  what  this 
gland  is.  It  was  speedily  found,  however,  to  be  a  large 
racemose  gland  consisting  of  six  lobes,  three  lying  in 
each  side  of  the  insect's  neck.  The  ducts  of  the  lobes 
finally  unite  in  the  common  channel  which  runs  along 
the  under  surface  of  the  head  and  enters  the  middle 


INSECTS   AND  DISEASE  in 

stylet,  or  lancet,  of  the  insect's  proboscis.  It  was  im- 
possible to  avoid  the  obvious  conclusion.  Observation 
after  observation  showed  that  the  blasts  collect  within 
the  cells  of  this  gland.  It  is  the  salivary  or  poison  gland 
of  the  insect,  similar  to  the  salivary  gland  found  in 
many  insects,  the  function  of  which  in  the  gnat  had 
already  been  discovered — although  I  was  not  aware  of 
the  fact.  That  function  is  to  secrete  the  fluid  which  is 
injected  by  the  insect  when  it  punctures  the  skin, 
fluid  which  causes  the  well-known  irritation  of  the 
puncture,  and  which  is  probably  meant  either  to  pre- 
vent the  contraction  of  the  torn  capillaries  or  the 
coagulation  of  the  ingested  blood.  .  .  .  The  blasts  must 
evidently  pass  down  the  ducts  of  the  salivary  gland 
into  the  wound  made  by  the  proboscis  of  the  insect, 
and  thus  cause  infection  in  a  fresh  'vertebrate  host. 

For  the  experiments  by  which  Major  Ross  con- 
firmed the  truth  of  this  observation  I  must  again 
refer  the  reader  to  the  original  article.  Suffice  it  to 
say  that  he  was  able  to  establish  conclusively  this 
last  link  in  the  chain,  and  thus  in  his  own  words,  to 
"  complete  the  original  and  fundamental  observa- 
tions on  the  life-history  of  the  hamamcebidee  in 
mosquitoes." 

In  1899  the  expedition  sent  to  Sierra  Leone  by 
the  Liverpool  Tropical  School  of  Medicine,  of 
which  Major  Ross  was  a  member,  confirmed  the 
results  of  his  experiments  in  every  respect,  and  his 
work  has  also  received  support  from  other  sources, 
especially  through  the  labours  of  Italian  scientists. 


ii2     WALTER   REED   AND  YELLOW   FEVER 

The  discovery  of  the  connection  between  the  mos- 
quito (of  the  genus  Anopheles)  and  malaria  was 
received  with  great  interest  not  only  by  the  scien- 
tific world,  but  by  the  laity,  and  it  has  been  put  to 
a  practical  test  in  the  protection  of  towns  and 
districts  from  malaria  through  the  systematic  de- 
struction of  the  mosquito. 

While  there  is  no  doubt  that  the  establishment  of 
a  connection  between  the  mosquito  and  malaria  led 
directly  up  to  thn  discovery  of  the  transmission  of 
yellow  fever  by  the  same  means,  yet  the  first  sug- 
gestion of  a  relation  between  the  mosquito  and  yel- 
low rever  preceded  the  investigation  of  the  origin 
of  malaria  by  a  good  many  years,  and  in  order  to 
follow  it  from  its  inception  we  must  retrace  our 
steps. 

So  far  as  I  can  find,  the  first  perso.a  Co  suggest 
that  insects  play  a  part  as  carriers  of  yellow  fever 
was  Dr.  J.  C.  Nott  of  Mobile,  in  1848,  in  a  paper 
entitled  "  On  the  Cause  of  Yellow  Fever."  Nott 
first  disputes  the  then  accepted  doctrine  that  mala- 
ria was  disseminated  by  means  of  a  gaseous  or 
molecular  emanation  from  the  earth's  surface,  dis- 
missing it  as  wholly  inadequate.  He  refers  to  the 
theory  of  transmission  of  disease  through  insects 
as  no  novelty,  and  mentions  Kircher,  as  well  as 
others  who  supported  it  in  the  past,  after  which 
he  reviews  a  number  of  facts  characteristic  of  ma- 


INSECTS  AND  DISEASE  113 

laria  that  are  readily  explicable  on  the  hypothe- 
sis of  insect  transmission,  but  on  no  other. 

Nott  then  describes  the  characteristics  of  yellow 
fever  and  shows  that  they,  as  well  as  many  of  the 
peculiarities  noted  in  connection  with  it,  such  as 
its  appearing  on  one  side  of  the  ship  without  in- 
fecting the  other,  are  comprehensible,  like  those 
of  malaria,  only  on  the  theory  of  insect  transmis- 
sion. "  With  these  facts  before  us,"  he  says,  "  how 
much  more  easily  may  we  account  for  the  spread  of 
yellow  fever  from  a  focus,  by  the  insect  theory  than 
by  the  malarial  hypothesis."  He  also  argues  that 
the  insect  theory  of  yellow  fever  explains  many  of 
the  facts  which  then  presented  difficulties  to  both 
contagionists  and  non-contagionists.  "  It  is  prob- 
able," he  says,  "  that  yellow  fever  is  carried  by  an 
insect  or  animalcule  bred  on  the  ground,  and  in 
what  manner  it  makes  its  impression  on  the  system 
is  but  surmise — but  unless  the  animalcule  is,  like 
that  of  psora,  bred  in  the  system,  we  could  no  more 
expect  it  to  be  contagious  than  the  bite  of  a  serpent. 
We  may,  therefore,  easily  understand  that  it  can 
at  the  same  time  be  transported  in  the  form  of  a 
germ  and  yet  not  be  contagious." 

To  Dr.  Carlos  J.  Finlay  of  Havana,  president 
of  the  Superior  Board  of  Health  of  Cuba,  belongs 
the  credit  of  first  formulating  a  definite  theory  as 
to  the  transmission  of  yellow  fever  by  means  of  the 


H4     WALTER   REED  AND  YELLOW   FEVER 

mosquito,  which  he  embodied  in  a  paper  read  be- 
fore the  Royal  Academy  of  Havana  on  August  n, 
1 88 1,  under  the  title,  "The  Mosquito  Hypotheti- 
cally  Considered  as  the  Agent  of  Transmission  of 
Yellow  Fever." 

Dr.  Finlay's  theory  as  stated  in  this  paper  is  as 
follows: 

Let  us  now  consider  by  what  means  the  mosquito 
might  transmit  the  yellow  fever,  if  that  disease  hap- 
pens to  be  really  transmissible  through  the  inoculation 
of  blood.  The  first  and  most  natural  idea  would  be 
that  the  transmission  might  be  effected  by  the  virulent 
blood  which  the  mosquito  has  sucked,  amounting  to 
5  to  7  cubic  millimetres,  and  which,  if  the  insect  hap- 
pens to  die  before  completing  its  digestion,  would  be 
in  excellent  condition  to  retain  during  a  long  period  its 
infecting  properties.  It  might  also  be  supposed  that 
the  same  blood  that  the  mosquito  discharges  as  excre- 
ment, after  having  bitten  a  yellow  fever  patient,  might 
be  dissolved  in  drinking  water,  whereby  the  infection 
might  be  conveyed,  if  the  latter  were  susceptible  of 
penetrating  by  the  mouth.  But  the  experiments  of 
Ffirth  and  other  considerations  arising  from  my  per- 
sonal ideas,  regarding  the  pathogenesis  of  yellow  fever, 
forbid  my  taking  into  account  either  of  these  modes 
of  propagation.  ...  A  valuable  collection  of  micro- 
photographs  from  preparations  made  by  our  corre- 
sponding member,  Surgeon-General  Sternberg,  showed 
what  to  me  appeared  to  be  a  most  striking  feature, 
namely,  that  the  red  blood  corpuscles  are  discharged 
unbroken  in  the  haemorrhages  of  yellow  fever.  This 


DR.    CARLOS    J.    FINLAY 

who  first  promulgated  the  theory  of  the  transmission  of  yellow  fever 
by  the  mosquito 


INSECTS  AND  DISEASE  115 

fact,  taken  into  consideration  with  the  circumstance 
that  these  haemorrhages  are  often  unattended  with 
any  perceptible  break  in  the  blood  vessels,  while,  on 
the  other  hand,  they  constitute  a  most  essential  clini- 
cal symptom  of  the  disease,  led  me  to  infer  that 
the  principal  lesion  of  yellow  fever  should  be  sought 
for  in  the  vascular  endothelium.  The  disease  is  trans- 
missible, it  attacks  the  same  person  but  once,  and  al- 
ways presents  in  its  phenomena  a  regular  order  compar- 
able with  that  observed  in  the  eruptive  fevers,  all  of 
which  circumstances  suggested  to  my  mind  the  hypothe- 
sis that  yellow  fever  should  be  considered  a  sort  of  erup- 
tive fever  in  which  the  seat  of  the  eruption  is  the  vascu- 
lar endothelium.  The  first  period  would  correspond  to 
the  initial  fever,  the  remission  to  the  eruptive  period, 
and  the  third  period  to  that  of  desquamation.  If 
the  latter  phase  is  accomplished  under  favourable 
conditions,  the  patient  will  only  show  evidence  of  an 
exaggerated  transudation  of  some  of  the  liquid  ele- 
ments of  the  blood  through  the  new  endothelium;  if 
the  conditions  are  unfavourable,  a  defective  endothelium 
will  have  been  produced,  incapable  of  checking  the 
escape  of  the.  figured  elements  of  the  blood;  passive 
haemorrhages  will  occur  and  the  patient  may  find  him- 
self in  imminent  danger.  Finally,  assimilating  the  dis- 
ease to  smallpox  and  to  vaccination,  it  occurred  to  me 
that  in  order  to  inoculate  yellow  fever  it  would  be 
necessary  to  pick  out  the  inoculable  material  from 
within  the  blood  vessels  of  a  yellow  fever  patient  and 
to  carry  it  likewise  into  the  interior  of  a  blood  vessel 
of  the  person  who  was  to  be  inoculated.  All  of  which 
conditions  the  mosquito  satisfies  most  admirably 
through  its  bite,  in  a  manner  which  it  would  be  almost 


n6     WALTER  REED  AND  YELLOW  FEVER 

impossible  for  us  to  imitate,  with  the  comparatively 
coarse  instruments  which  the  most  skilful  makers  could 
produce. 

Three  conditions  will,  therefore,  be  necessary  in 
order  that  yellow  fever  may  be  propagated:  (i)  The 
existence  of  a  yellow  fever  patient  into  whose  capil- 
laries the  mosquito  is  able  to  drive  its  sting  and  to  im- 
pregnate it  with  the  virulent  particles,  at  an  appro- 
priate stage  of  the  disease.  (2)  That  the  life  of  the 
mosquito  may  be  spared  after  its  bite  upon  the  patient 
until  it  has  a  chance  of  biting  the  person  in  whom  the 
disease  is  to  be  reproduced.  (3)  The  coincidence  that 
some  of  the  persons  whom  the  same  mosquito  happens 
to  bite  thereafter  shall  be  susceptible  of  contracting 
the  disease. 

Dr.  Finlay  continued  to  keep  the  subject  in  view, 
and  he  made  a  number  of  valuable  contributions 
to  it  during  the  next  ten  or  fifteen  years,  although 
as  time  advanced  his  ideas  underwent  some  modifi- 
cation. His  original  theory,  based  on  the  studies 
made  by  Theobald  Smith  on  Texas  fever,  was  that 
the  specific  poison  adhered  to  the  mosquito's  pro- 
boscis and  was  thus  mechanically  transferred  to  the 
individual  next  bitten,  but  he  changed  this  view 
"  so  as  to  include  the  important  circumstance  that 
the  faculty  of  transmitting  the  yellow  fever  germ 
need  not  be  limited  to  the  parent  insect,  directly 
contaminated  by  stinging  a  yellow  fever  patient, 
(or  perhaps  by  constant  contact  with  or  feeding 


INSECTS   AND  DISEASE  117 

from  his  discharges,)  but  may  be  likewise  inherited 
by  the  next  generation  of  mosquitoes  issued  from 
the  contaminated  parent."  He  also  claimed,  as 
time  went  on,  that  the  specific  cause  of  the  disease 
was  the  micrococcus  tetragenus. 

During  the  years  following  Finlay's  first  con- 
tribution the  aetiology  of  yellow  fever  was  much 
before  the  minds  of  scientists.  After  the  brilliant 
results  in  the  causation  of  disease  obtained  by  Koch 
and  Pasteur,  bacteriologists  naturally  looked  upon 
yellow  fever  as  a  promising  field  for  exploration. 
In  1885  Dr.  Domingo  Freire  of  Rio  de  Janeiro 
claimed  to  have  found  its  specific  cause  in  an  or- 
ganism which  he  named  "  Cryptococcus  zantho- 
genicus."  He  obtained  such  favourable  results 
from  inoculating  human  beings  with  attenuated 
cultures  of  this  organism  for  the  purpose  of  con- 
ferring immunity  that  he  received  a  grant  from 
the  state  to  enable  him  to  continue  his  investiga- 
tions. The  work  attracted  considerable  attention, 
and  he  continued  to  report  favourable  results  until 
1887,  when  Dr.  Sternberg  of  the  United  States 
Army  was  sent  to  Rio  de  Janeiro  for  the  purpose  of 
investigating  into  and  reporting  upon  the  merits 
of  the  inoculations.  Dr.  Sternberg's  report,  how- 
ever, was  not  encouraging,  for  he  found  that  the 
cultures  made  over  to  him  by  Freire  for  examina- 
tion did  not  agree  with  the  published  descriptions 


n8     WALTER   REED   AND   YELLOW   FEVER 

of  his  organism;  moreover,  the  organism  itself 
proved  to  be  the  common  staphylococcus  pyogenes 
albus. 

Dr.  Carmona  y  Valle  of  Mexico,  in  1885,  pub- 
lished the  description  of  an  organism  which  he 
considered  to  be  the  cause  of  yellow  fever,  but  his 
claim,  as  well  as  that  of  Dr.  Finlay  for  the  micro- 
coccus  tetragenus,  were  disposed  of  by  Dr.  Stern- 
berg,  who  showed  that  both  these  bacteria  were 
common  organisms  that  could  be  obtained  from 
various  sources.  In  1888  Sternberg  began  an  ex- 
amination of  the  blood  in  yellow  fever  cases  in 
Havana,  investigating  both  blood  from  different 
organs  and  the  contents  of  the  intestinal  tract,  but 
without  result,  for,  in  his  final  report,  he  stated 
that  the  specific  agent  of  the  disease  had  not  been 
demonstrated. 

The  aetiology  of  yellow  fever  remained,  there- 
fore, an  undiscovered  country.  The  knowledge  of 
the  disease  acquired  during  a  century  of  its  more 
or  less  disastrous  visitations  amounted  to  very  little. 
The  old  idea  that  the  disease  was  spontaneously 
generated  from  organic  decomposition  under  fa- 
vorable conditions  had,  of  course,  died  a  natural 
death  with  the  development  of  bacteriology  as  a 
science,  and  it  was  universally  regarded  as  an  im- 
portation. The  old  theory  of  contagion,  which  had 
been  the  subject  of  such  heated  controversy  early 


INSECTS   AND  DISEASE  119 

in  the  nineteenth  century,  appeared  at  its  close 
under  a  new  form.  Direct  transmission  from  one 
person  to  another  through  the  emanations  from  the 
body  was  no  longer  accredited,  but  its  place  was 
taken  by  the  doctrine  of  fomites,  which  was  sup- 
posed to  afford  a  full  explanation  of  its  means  of 
conveyance  and  to  account  satisfactorily  for  its 
transmission  over  great  distances.  The  idea  of 
studying  the  disease  from  the  standpoint  of  its 
transportal  had  as  yet  occurred  to  no  one  but  Dr. 
Finlay,  and  the  scientific  world  in  general  was  oc- 
cupied in  a  search  for  the  specific  agent  which,  it 
was  assumed,  must  be  discovered  before  the  nature 
of  the  disease  could  be  satisfactorily  investigated. 
Such  was  the  condition  of  knowledge,  or  rather 
of  ignorance,  concerning  yellow  fever  when  Dr. 
Reed  took  up  the  problem. 


CHAPTER  VI 

WORK   IN   YELLOW   FEVER 
1897-1901 

Dream  not  helm  nor  harness 

The  sign  of  Valor  true; 
Peace  hath  higher  test  of  manhood 

Than  battle  ever  knew. 

— WHITTIER.  The  Hero. 

THE  British  Medical  Journal  for  July  3,  1897, 
contained  the  announcement  that,  during  the  pre- 
ceding year,  the  specific  cause  of  yellow  fever  had 
been  discovered  by  the  Italian  scientist,  Dr.  Giu- 
seppe Sanarelli,  in  the  form  of  a  bacillus  named 
by  him  bacillus  icteroides.  This  statement  was  re- 
ceived with  great  interest  by  the  scientific  world, 
and  by  no  one  more  gladly  than  Dr.  Reed,  who 
expressed  the  hope  that  Sanarelli's  work  would 
soon  be  confirmed  by  other  observers.  Shortly  af- 
terwards Reed  himself,  together  with  Dr.  James 
Carroll,  U.  S.  A.*  was  appointed  by  Surgeon-Gen- 
eral Sternberg  to  investigate  Sanarelli's  bacillus 
and  compare  it  with  the  bacillus  x,  which  Stern- 
berg  had  obtained  from  the  bodies  of  yellow  fever 
patients  during  the  summer  of  1887.  The  investi- 

120 


WORK   IN   YELLOW   FEVER  m 

gation  was  begun  with  the  desire  on  the  part  of  the 
workers,  as  they  themselves  state,  of  confirming 
Sanarelli's  observations.  Their  work,  however,  as 
it  proceeded,  revealed  such  strong  structural  re- 
semblances between  the  bacillus  icteroides  and  the 
bacillus  of  hog-cholera  that  it  was  determined  to 
institute  a  different  line  of  research,  which  soon 
convinced  them  that  Sanarelli's  bacillus  was  really 
a  variety  of  the  hog-cholera  bacillus,  and  that  if  it 
was  present  in  yellow  fever  at  all,  it  must  be  re- 
garded as  a  secondary  invader. 

The  results  of  their  investigation  were  formally 
expressed  by  Reed  and  Carroll  in  a  "preliminary; 
note,"  published  in  the  Medical  News  for  April  29, 
1899;*  Sanarelli  challenged  it  four  months  later 
in  the  same  journal,2  denying  the  truth  of  the  state- 
ments made  by  Reed  and  Carroll,  explaining  their 
failure  to  confirm  his  results  by  their  employment 
of  faulty  methods,  and  even  accusing  them  of  lend- 
ing themselves  to  the  support  of  a  personal  con- 
troversy between  himself  and  General  Sternberg. 
Reed  and  Carroll  replied  to  this  attack  without 
loss  of  time,  showing  beyond  any  possibility  of 
doubt  that  Sanarelli's  hostile  criticisms  of  their 

1  "  Bacillus  icteroides  and  bacillus  cholerae  suis — A  Prelim- 
inary Note."    Med.  News,  April  29,  1899. 

2  "  Some  Observations  and  Controversial   Remarks  on  the 
Specific  Cause  of  Yellow  Fever."    Med.  News,  Aug.  12,  1899. 


122     WALTER   REED   AND  YELLOW   FEVER 

work  were  without  foundation,  and  meeting  his 
personal  innuendoes  with  gentlemanly  forbear- 
ance.3 In  December,  1900,  they  were  able  to  pub- 
lish the  complete  report  of  their  investigations, 
which  supplied  overwhelming  experimental  proof 
that  the  bacillus  icteroides  belongs  to  the  hog- 
cholera  group.4 

Before  the  appearance  of  this  complete  report, 
however,  additional  evidence  in  support  of  Reed 
and  Carroll's  results  had  been  supplied  through 
the  investigations  of  Dr.  Aristides  Agramonte, 
Assistant  Surgeon,  U.  S.  A.,  who,  during  1898  had 
studied  the  bacillus  icteroides  and  the  bacillus  x 
in  Dr.  Reed's  laboratory,  and  was  then  sent  to 
Cuba,  where  he  succeeded  in  isolating  Sanarelli's 
bacillus  from  about  thirty-three  per  cent,  of  the 
yellow  fever  cases  examined  at  Santiago,  but  also 
obtained  it  from  cases  that  were  not  yellow  fever. 

Early  in  the  year  1900,  yellow  fever  appeared 
among  the  American  troops  stationed  at  Havana, 
and  became  quite  prevalent  during  the  summer. 
In  order  to  take  advantage  of  this  opportunity  for 
investigating  the  aetiology  of  the  disease,  a  com- 

3  "  The  Specific  Cause  of  Yellow  Fever."   A  Reply  to  Dr. 
G.  Sanarelli.     Med.  News,  Sept.  9,  1899. 

4  "  A  Comparative  Study  of  the  Biological  Characters  and 
Pathogenesis   of    Bacillus    x    (Sternberg),    Bacillus    icteroides 
(Sanarelli),    and    the    Hog-Cholera    Bacillus    (Salmon    and 
Smith)."  Jour.  Exper.  Med.,  1900,  vol.  V,  p.  215. 


WORK   IN   YELLOW  FEVER  123 

mission  of  medical  officers  from  the  United  States 
was  appointed  and  ordered  to  meet  at  Havana  for 
the  purpose.  The  officers  composing  the  board 
were:  Dr.  Walter  Reed,  Dr.  James  Carroll,  and 
Dr.  Jesse  W.  Lazear,  all  non-immunes,  and  Dr. 
Aristides  Agramonte,  a  Cuban  immune.  Dr.  Agra- 
monte  and  Dr.  Lazear  were  already  in  Cuba  and 
Dr.  Reed  and  Dr.  Carroll  joined  them  at  Havana 
in  June,  1900. 

The  work  of  the  Commission  was  divided  among 
its  members  as  follows:  Dr.  Reed,  the  chairman, 
was  at  the  head  of  affairs;  Dr.  Carroll  had  charge 
of  the  bacteriological  investigations;  Dr.  Lazear 
had  the  mosquito  work,  for  he  was,  at  that  time,  the 
only  member  of  the  board  acquainted  with  the 
mosquito ;  and  Dr.  Agramonte  was  in  charge  of  the 
autopsies  and  of  the  pathological  work. 

The  first  efforts  of  the  Commission  were  directed 
to  a  conclusive  experiment  on  the  true  nature  of 
the  bacillus  icteroides.  For  this  purpose  cultures 
drawn  during  life  from  the  blood  of  eighteen 
patients  were  carefully  studied,  but  as  the  bacillus 
icteroides  could  not  be  obtained  from  any  of  them, 
nor  from  cultures  made  at  eleven  autopsies  on 
yellow  fever  patients,  it  was  considered  established 
beyond  all  doubt  that  it  might  be  excluded  from 
farther  consideration. 

Two  separate  lines  of  work  now  presented  them- 


124     WALTER   REED   AND   YELLOW   FEVER 

selves :  one,  the  study  of  the  bacterial  flora  of  the 
intestine  and  anerobic  cultures  from  the  blood  and 
various  organs  of  yellow  fever  patients ;  the  other, 
the  transmission  of  the  disease  according  to  the 
theory  of  insect  conveyance  advanced  by  Dr.  Fin- 
lay,  in  1 88 1. 

It  happened  that  just  at  this  time  an  opportunity 
was  afforded  Dr.  Reed  to  investigate  an  epidemic 
of  yellow  fever  prevailing  at  Pinar  del  Rio  Bar- 
racks, about  one  hundred  and  two  miles  from  Ha- 
vana. In  company  with  Dr.  Agramonte,  Dr.  Reed 
made  a  visit  there  on  July  31,  1900,  and  performed 
an  autopsy  on  a  yellow  fever  patient  that  after- 
noon. .  .  .  His  own  description  of  the  visit  and  the 
conclusions  he  drew  from  it  are  as  follows : 5 

The  lesions  found  were  those  of  yellow  fever.  In- 
quiry showed  that  under  the  diagnosis  of  "  remittent 
malarial  fever,"  or  "pernicious  malarial  fever,"  the 
disease  had  been  prevailing  for  at  least  thirty-seven 
days  prior  to  our  arrival,  July  31,  and  that  about  thirty- 
five  cases  had  been  under  treatment  in  the  post  hospital, 
of  which  number  eleven  had  died.  As  the  true  nature  of 
the  disease  had  not  been  suspected,  no  precautionary 
measures  had  been  taken  as  regards  the  disinfection 
of  bedding  and  clothing  used  by  the  patients,  except 
that  in  case  of  death,  the  sheets  and  pillow  slips  were 
put  into  bichloride  solution  and  the  mattress  and  pillow 

5  "  The  Propagation  of  Yellow  Fever ;  Observations  based 
on  recent  Researches."  Med.  Rec.,  Aug.  10,  1901. 


WORK   IN   YELLOW   FEVER  125 

exposed  to  sunlight.  An  order  required  that  the  excreta 
of  all  patients  under  treatment  in  this  hospital  should 
be  carefully  disinfected,  and  this  was  probably  carried 
out  fairly  well.  .  .  .  Notwithstanding  the  omis- 
sion to  disinfect  the  bulk  of  the  contaminated  articles 
of  bedding  and  clothing,  the  disease  had  not  been  con- 
tracted by  the  nurses,  nor  by  the  three  men  who 
washed  all  of  these  articles.  A  little  inquiry  showed  that 
contaminated  clothing  was  in  all  of  the  eight  barrack- 
rooms  without  apparent  detriment  to  the  occupants. 
Further  investigation  showed  that  a  death  from  yellow 
fever  had  occurred  in  this  garrison  as  early  as  May  16, 
1900,  and  that  the  source  of  infection  for  this  case,  as 
well  as  for  the  present  outbreak,  was  in  the  immediately 
adjacent  town  of  Pinar  del  Rio,  to  which  the  soldiers 
had  free  access. 

i  An  interesting  observation  was  the  sudden  attack  of 
yellow  fever  experienced  on  July  12,  1900,  by  a  gen- 
eral prisoner  who  had  been  confined  in  a  cell  in  the 
guard  house  since  June  6,  1900.  His  death  occurred 
at  the  post  hospital  on  July  18,  1900.  This  cell 
was  occupied,  at  the  time,  by  eight  other  prisoners, 
none  of  whom  contracted  the  disease,  although  one  of 
them  continued  to  occupy  the  bunk  vacated  by  the  sick 
man.  As  these  nine  prisoners  had  been  kept  under 
strict  military  guard,  it  was  impossible  that  the  in- 
dividual attacked  could  have  acquired  his  infection  in 
the  town  of  Pinar  del  Rio.  He  was,  as  far  as  could 
be  ascertained,  exposed  to  no  source  of  infection  to 
which  his  companions  had  not  been  equally  exposed, 
and  yet  he  alone  acquired  the  disease.  It  was  conjec- 
tured at  the  time  that,  perhaps,  some  insect  capable  of 


ia6     WALTER   REED   AND  YELLOW   FEVER 

conveying  the  infection,  such  as  the  mosquito,  had  en- 
tered through  the  cell  window,  bitten  this  particular 
prisoner,  and  then  passed  out  again.  This,  however, 
was  only  a  supposition. 

Two  instances  of  undoubted  exposure  to  fomites 
involving  four  individuals  came  under  my  observation 
during  this  inspection.  In  the  one  case  a  box  of  cloth- 
ing belonging  to  a  soldier  who  had  died  of  yellow 
fever  on  July  3,  and  which  had  been  packed  by  an 
enlisted  man  on  July  4  and  placed  in  the  company 
store-room,  was  unpacked  for  the  purpose  of  making 
an  inventory  of  the  articles,  and  carefully  repacked  on 
July  1 8  by  two  non-immune  soldiers,  who  did  not 
contract  the  disease  by  this  exposure.  In  the  other  case, 
the  very  bed  vacated  on  July  18  by  the  Commissary 
Sergeant,  who  was  taken  sick  on  July  17,  and  died  on 
July  21,  was  occupied  by  a  non-immune  soldier  on  the 
night  of  the  I9th  and  2oth  of  July.  Although  this 
individual  was  badly  frightened  when  the  true  char- 
acter of  the  sergeant's  attack  was  announced,  the  com- 
bination of  fright  and  exposure  to  fomites  was  not 
sufficient  to  produce  an  attack  of  yellow  fever. 

It  happened  that  Dr.  Reed  had  been  much  im- 
pressed by  the  valuable  observations  made  at  Or- 
wood  and  Taylor,  Mississippi,  during  the  year 
1898  by  Surgeon  Henry  R.  Carter  of  the  U.  S.  Ma- 
rine Hospital  Service,  on  the  interval  between  in- 
fecting and  secondary  cases  of  yellow  fever.6  The 
circumstances  under  which  Carter  worked  were 
favourable  for  recording  the  time  between  the 
6  New  Orleans  Med.  Jour.,  May,  1900. 


WORK    IN   YELLOW   FEVER  127 

arrival  of  infecting  cases,  in  isolated  farmhouses, 
and  the  occurrence  of  secondary  cases  in  these 
houses.  According  to  him,  "  The  period  from  the 
first  (infecting)  case  to  the  first  group  of  cases  in- 
fected at  these  houses  is  generally  from  two  to  three 
weeks.  The  houses  having  become  infected,  sus- 
ceptible individuals  who  visited  them  for  a  few 
hours  fell  sick  with  the  disease  in  the  usual  period 
of  incubation — one  to  seven  days."  Observations 
made  by  the  Commission  confirmed  Carter's  con- 
clusions, and  pointed,  in  Dr.  Reed's  opinion,  to  the 
presence  of  an  intermediate  host,  such  as  the  mos- 
quito, which  having  taken  the  parasite  into  its 
stomach  soon  after  the  entrance  of  the  patient  into 
a  non-infected  house,  was  able  after  a  certain 
interval  to  reconvey  the  infecting  agent  to  other 
individuals.  This  interval  appeared  to  be  from 
nine  to  sixteen  days  (allowing  for  the  period  of 
incubation). 

All  these  data  induced  Dr.  Reed  to  form  the  fol- 
lowing opinion : 7 

At  this  stage  of  our  investigation,  it  seemed  to  me, 
and  I  so  expressed  the  opinion  to  my  colleagues,  that 
the  time  had  arrived  when  the  plan  of  our  work  should 
be  radically  changed  and  that  the  search  for  the  spe- 
cific agent  of  yellow  fever,  while  not  abandoned,  should 

7  "  The  Propagation  of  Yellow  Fever :  Observations  Based 
on  Recent  Researches."  Loc.  cit. 


128     WALTER   REED   AND   YELLOW   FEVER 

be  given  secondary  consideration,  until  we  had  first 
definitely  learned  something  about  the  way  or  ways  in 
which  the  disease  was  propagated  from  the  sick  to  the 
well.  I  felt  well-nigh  convinced  that  we  could  obtain 
no  light  whatever  upon  the  task  that  had  been  set  be- 
fore us,  unless  we  substituted  this  line  of  work  for  the 
one  we  had  been  pursuing,  and  that  in  view  of  the 
splendid  work  of  Ross,  Bignami,  and  others  with  re- 
gard to  the  propagation  of  malarial  fever,  together 
with  the  well-known  thermal  influences  intimately  con- 
nected not  only  with  the  epidemiology  of  the  disease 
in  the  United  States,  but  also  with  its  endemiology  on 
the  Island  of  Cuba,  it  was  of  the  highest  importance 
that  the  agency  of  an  intermediate  host,  such  as  the 
mosquito,  should  either  be  proven  or  disproven. 

"  Notwithstanding  the  fact,"  Dr.  Reed  remarks 
elsewhere,  "  that  Finlay  had  no  results  to  show  in 
support  of  his  theory,  and  that  the  latter  had  been 
rejected  by  other  investigators,  the  argument  in 
favour  of  an  intermediate  host  seemed  so  strong, 
as  I  have  already  said,  that  investigation  along  this 
line  was  determined  upon." 

The  mosquito  selected  was  that  used  by  Finlay, 
and  spoken  of  by  him  as  Culex  fasciatus.  Culex, 
however,  is  an  old  genus,  named  by  Linna3us  in 
1735,  which  for  a  long  time  contained  all  the  mos- 
quitoes. But  other  genera  have  been  erected,  and 
now  the  mosquitoes  are  included  in  a  family  known 
as  the  Culicidae,  which  comprises  several  genera 


WORK   IN   YELLOW   FEVER  129 

and  very  many  species.  Culex,  however,  is  the 
typical  genus  and  includes  the  commoner,  most 
abundant,  and  most  widespread  kinds  of  mosqui- 
toes. The  particular  species  of  mosquito  used  by 
Dr.  Finlay  in  his  original  experiments  is  the  one 
referred  to  in  this  country  as  Culex  fasciatus, 
Fabricius;  but  Mr.  F.  V.  Theobald,  who  has  been 
investigating  the  mosquitoes  of  the  world,  on  behalf 
of  the  British  Museum,  and  has  made  a  morpho- 
logical study  of  these  insects,  has  decided  that  Culex 
'fasciatus  is  not  to  be  contained  in  the  genus  Culex, 
but  on  account  of  scale  structure  and  other  struc- 
tural peculiarities  it  must  be  placed  in  another 
genus,  which  has  received  the  name  Stegomyia. 
It  is  the  female  of  one  particular  species,  Stegomyia 
fas  data,  which  Dr.  Reed  made  use  of  in  his  experi- 
ments upon  yellow  fever,  and  which,  as  we  shall 
presently  see,  he  demonstrated  to  be  the  interme- 
diate host  for  the  parasite  of  the  disease. 

The  malarial  mosquito  (see  Chapter  V.,  p.  112), 
belongs  to  another  genus,  namely,  Anopheles, 
founded  by  Meigen  in  1818.  There  are  three  spe- 
cies of  Anopheles  in  the  United  States :  A.  maculi- 
pennis  Meigen,  A.  punctipennis  Say,  and  A. 
crucians  Wied.  It  is  not  known  whether  the  insect 
was  introduced  from  Europe  to  America  or  the  re- 
verse. It  is  quite  within  the  bounds  of  possibility 
that  malaria  was  originally  an  European  disease, 


130     WALTER   REED   AND   YELLOW   FEVER 

i 

and  that  not  only  was  the  disease  itself  carried  from 
there  on  sailing  vessels,  but  the  mosquito  which 
propagated  it  as  well — at  any  rate  to  America. 

The  following  description  of  Stegomyia  fasciata, 
its  appearance,  habitat,  and  breeding  places  is 
abridged  from  Dr.  Reed's  account  of  it: 

This  mosquito  is  rather  a  striking  looking  insect.  It 
has  conspicuous  markings  of  a  broad,  semilunar,  sil- 
very stripe  on  the  lateral  surface  of  the  thorax,  and 
white  stripes  at  the  bases  of  the  tarsal  joints.  Four 
stripes  of  silvery  scales  seen  on  the  posterior  surface  of 
the  thorax  distinguish  this  species  from  all  others,  ex- 
cept Stegomyia  signifer.  It  has  a  widespread  distribu- 
tion, being  found  in  all  the  principal  cities  of  Cuba,  as 
well  as  in  almost  all  the  southern  countries  of  Europe, 
and  the  Southern  States  of  this  country.  Its  breeding 
places  are  in  rainwater  barrels  or  sagging  gutters  con- 
taining water,  and  indeed  in  all  places  where  stagnant 
water  has  collected.  The  female  lays  her  eggs  during 
the  night,  extruding  them  on  the  surface  of  the  water 
in  pairs,  in  groups  of  three  or  more,  or  singly.  The 
number  of  eggs  deposited  varies  from  twenty  to  about 
seventy-five.  They  are  jet  black  in  colour  and,  to  the 
naked  eye,  cylindrical  in  shape.  Under  a  low  power  of 
the  microscope  the  surface  of  the  egg  is  seen  to  be 
marked  by  tolerably  regular  six-sided  plates,  each  of 
which  has  a  little  round  elevation  in  the  centre,  that 
gives  the  surface  a  roughened  appearance.  The  eggs 
are  singularly  resistant  to  external  influences.  Dried 
eggs  can  be  easily  hatched  at  the  end  of  three  months 


WORK    IN   YELLOW   FEVER  131 

and  freezing  does  not  destroy  their  fertility.  The  eggs 
are  laid  after  a  meal  of  blood  after  an  interval  varying 
from  two  to  thirty  days — as  a  rule  within  seven  days — 
and  under  favourable  conditions  of  warmth  (i.  e.,  a 
summer  temperature)  they  begin  to  hatch  on  the  third 
day.  The  larval  stage  occupies  seven  to  eight  days  and 
the  pupal  stage  about  two  days.  The  impregnated 
female  bites  at  a  temperature  of  62°  F.  and  above,  but 
at  a  lower  temperature  even  very  hungry  females  will 
not  bite;  the  unimpregnated  female  does  not  appear 
to  bite  at  all.  Unlike  culex  pungens,  this  mosquito  bites 
by  day  as  well  as  by  night.  8 

The  line  of  work  being  finally  determined,  there 
at  once  arose  the  tremendous  responsibility  in- 
volved in  the  use  of  human  beings  for  experimental 
purposes.  After  careful  consideration  the  Com- 
mission reached  the  conclusion  that  the  results,  if 
positive,  would  be  of  sufficient  service  to  humanity 
to  justify  the  procedure,  provided,  of  course,  that 
each  individual  subjected  to  experiment  was  fully 
informed  of  the  risks  he  ran,  and  gave  his  free  con- 
sent. The  members  of  the  Commission,  however, 
agreed  that  it  was  their  duty  to  run  the  risk  in- 
volved themselves,  before  submitting  anyone  else 
to  it. 

It  became  necessary  just  at  this  time  for  Dr. 

8  "  The  Prevention  of  Yellow  Fever."  Med.  Rec.,  Oct.  26, 
1901, 


132    WALTER   REED   AND   YELLOW  FEVER 

Reed  to  return  to  this  country,  and  the  work  was 
left  in  charge  of  Dr.  Carroll.  The  experiments 
were  begun  by  Dr.  Lazear,  who  applied  a  number 
of  infected  mosquitoes,  hatched  from  eggs  fur- 
nished by  Dr.  Finlay,  to  several  persons,  himself 
included,  without  result.  On  the  afternoon  of  Au- 
gust 27  a  second  attempt  was  made,  in  which  Dr. 
Carroll  submitted  to  the  bite  of  an  infected  mos- 
quito, applied  by  Dr.  Lazear.  The  description  of 
this,  the  first  successful  experiment,  is  best  given 
in  Dr.  Carroll's  own  words.9 

The  insect,  which  had  been  hatched  and  reared  in 
the  laboratory,  had  been  caused  to  feed  upon  four  cases 
of  yellow  fever,  two  of  them  severe  and  two  mild. 
The  first  patient,  a  severe  case,  was  bitten  twelve  days 
before,  the  second,  third,  and  fourth  patients  had  been 
bitten  six,  four,  and  two  days  previously,  and  their 
attacks  were  in  character,  mild,  severe,  and  mild,  re- 
spectively. In  writing  to  Dr.  Reed  on  the  night  after 
the  incident  I  remarked  jokingly  that  if  there  were 
anything  in  the  mosquito  theory  I  should  have  a  good 
dose;  and  so  it  happened.  After  having  slight  pre- 
monitory symptoms  for  two  days  I  was  taken  sick  on 
August  31,  and  on  September  i  I  was  carried  to  the 
yellow  fever  camp.  My  life  was  in  the  balance  for 
three  days,  and  my  chart  shows  that  on  the  fifth,  sixth, 

9  "  A  Brief  Review  of  the  Etiology  of  Yellow  Fever."  N.  Y. 
Med.  Jour,  and  Phil.  Med.  Jour,  (consol.),  Feb.  6  and  13, 
1904. 


WORK   IN   YELLOW   FEVER  133 

and  seventh  days  my  urine  contained  eight-tenths  and 
nine-tenths  of  moist  albumen.  The  tests  were  made  by 
Dr.  Lazear.  I  mention  this  particularly  because  the  re- 
sults obtained  in  this  case  do  not  agree  with  the  twen- 
tieth conclusion  of  Marchoux,  Salimbeni,  and  Simond, 
that  the  longer  the  interval  that  elapses  after  infec- 
tion of  the  mosquito  the  more  dangerous  he  becomes. 
Twelve  days,  the  period  above  cited,  is  the  shortest 
time  in  which  the  mosquito  has  been  proved  to  be 
capable  of  conveying  the  infection.  It  is  my  opinion 
that  the  susceptibility  of  the  individual  bitten  is  a  much 
more  potent  factor  in  determining  the  severity  of  the 
attack  than  the  duration  of  the  infection  in  the  mos- 
quito, or  the  number  of  mosquitoes  applied.  On  the 
day  that  I  was  taken  sick,  August  31,  1900,  Dr.  La- 
zear applied  the  same  mosquito,  with  three  others,  to  an- 
other individual  who  suffered  a  comparatively  mild  at- 
tack, and  was  well  before  I  left  my  bed.  Thus  it  hap- 
pened that  I  was  the  first  person  to  whom  the  mosquito 
was  proved  to  convey  the  disease.  On  the  eighteenth 
day  of  September,  five  days  after  I  was  permitted  to 
leave  my  bed,  Dr.  Lazear  was  stricken  and  died  in 
convulsions  just  one  week  later,  after  several  days  of 
delirium  with  black  vomit.  Such  is  yellow  fever. 


As  soon  as  Dr.  Carroll  fell  ill,  Dr.  Lazear  ap- 
plied the  insects  which  had  bitten  him,  together 
with  three  others,  to  another  subject  mentioned  in 
the  report  as  X.  Y.,  who  also  succumbed  to  the  dis- 
ease after  the  usual  period  of  incubation.  In  doing 
this  Lazear  was  actuated  by  the  scientific  spirit, 


134      WALTER   REED  AND   YELLOW   FEVER 

for  he  confirmed  the  source  of  infection  in  Dr. 
Carroll's  case,  while  at  the  same  time  he  secured 
additional  proof  regarding  the  transmission  of  the 
disease  by  the  mosquito.  The  entire  series  of  pre- 
liminary experiments  consisted  of  eleven  cases, 
nine  of  which  were  negative;  it  was  felt,  however, 
that  the  negative  results  might  be  attributed  to  the 
fact  that  the  insects  used  in  them  had  not  been  kept 
long  enough  after  biting  yellow  fever  patients. 
The  two  positive  cases  were  therefore  considered 
sufficiently  encouraging  to  justify  advancing  along 
the  line  of  investigation  already  proposed,  espe- 
cially as  the  movements  of  both  patients  in  the  suc- 
cessful cases  were  known  to  the  Commission  for 
some  weeks  prior  to  their  inoculation,  and  gave 
reasonable  assurance  that  no  other  source  of  infec- 
tion had  been  possible. 

The  death  of  Dr.  Lazear,  mentioned  by  Dr. 
Carroll,  occurred  in  consequence  of  an  accidental 
inoculation.  He  had  been  experimentally  bitten, 
as  I  have  said  above,  without  any  result,  but  a 
short  time  afterwards  a  mosquito  settled  on  his 
hand  while  he  was  collecting  blood  from  a  yellow 
fever  patient  for  purposes  of  investigation,  and  he 
allowed  it  to  take  its  fill.  He  did  not  at  the  time 
believe  it  to  belong  to  the  species  stegomyia,  and 
said  nothing  about  the  occurrence  to  his  associates. 
In  due  course  of  time,  however,  he  was  taken  ill 
with  yellow  fever  in  its  most  virulent  form,  and 


WORK   IN   YELLOW   FEVER  135 

died  within  a  week.  His  death  was  an  irreparable 
loss  to  the  Commission,  but  I  will  not  pause  here 
to  dwell  on  his  many  claims  to  admiration  and  re- 
spect, for  I  shall  speak  of  them  at  length  in  their 
own  time  and  place  (see  Chapter  XI). 

Dr.  Reed  returned  to  find  the  first  series  of  ex- 
periments, upon  which  the  utility  of  the  mosquito 
theory  as  a  working  hypothesis  must  rest,  already 
accomplished  through  the  exertions  of  his  col- 
leagues, and  the  Preliminary  Note  for  publication 
was  immediately  begun.  As  Lazear's  infection  was 
accidental,  his  case  is  not  officially  cited  in  the  re- 
port, though  it  is  mentioned  incidentally;  but,  as 
the  bite  was  received  while  he  was  actually  in  the 
yellow  fever  ward,  the  presumptive  evidence  in 
favor  of  his  infection  through  the  mosquito  is  very 
strong.  The  two  positive  cases,  however,  were  con- 
sidered by  the  Commission  sufficient  evidence  to 
justify  them  in  stating  before  the  Public  Health 
Association  at  Indianapolis  in  October,  1900,  that 
u  The  mosquito  acts  as  the  intermediate  host  for 
the  parasite  of  yellow  fever"  10 

The  first  stage  in  the  investigation  thus  com- 
pleted, it  became  evident  that,  if  further  experi- 
ments were  to  be  of  permanent  value  to  humanity, 
some  means  must  be  provided  by  which  perfect 

10  "The  Etiology  of  Yellow  Fever:  A  Preliminary  Note." 
Address  before  the  American  Health  Assoc.,  Indianapolis,  Oct., 
1900. 


136    WALTER   REED   AND   YELLOW   FEVER 

control  could  be  exercised  over  the  movements  of 
the  individuals  subjected  to  inoculation,  in  order 
to  exclude  every  possible  source  of  infection  ex- 
cept the  mosquito.  An  experimental  sanitary  sta- 
tion was,  therefore,  established,  in  an  open,  uncul- 
tivated field,  about  one  mile  from  the  town  of 
Quemados,  Cuba,  on  a  site  which  was  well  drained 
and  freely  exposed  to  both  sun  and  wind.  This 
station,  which  was  named  Camp  Lazear  in  mem- 
ory of  the  deceased  member  of  the  Commission, 
was  placed  under  Dr.  Reed's  entire  control,  and 
he  speaks  of  it  thus :  u 

Any  location  selected,  provided  it  should  be  one  mile 
from  such  a  centre  of  infection  and  surrounded  by 
proper  safeguards,  would  be  just  as  free  from  the  oc- 
currence of  yellow  fever  as  if  it  were  located  ten  miles 
from  such  a  town.  My  own  experience  on  the  Island 
of  Cuba  had  already  taught  me  that  yellow  fever  could 
be  easily  kept  out  of  a  military  garrison,  although  pre- 
vailing in  epidemic  form  in  a  town  less  than  one  mile 
distant.  For  this  reason  it  was  not  considered  advisa- 
ble to  establish  our  experimental  sanitary  station  at  a 
greater  distance  than  one  mile  from  Quemados,  Cuba. 
Thus  Camp  Lazear  could  easily  be  reached  by  the 
members  of  the  Board  and  was  conveniently  located  as 
regards  its  basis  of  supplies. 

The  personnel  of  the  camp,  in  addition  to  the 
three  surviving  members  of  the  Commission,  con- 

11  "  The  Propagation  of  Yellow  Fever."  Med.  Record,  Aug. 
IO,  1901. 


CAMP    LAZEAR 

where  the  experiments  with  theyellow  fever  mosquito  were  first  carried 
out  ami  the  transmission  of  the  disease  by  this  means  proven 


WORK   IN   YELLOW    FEVER  137 

sisted  of  Dr.  Roger  P.  Ames,  an  immune,  in  im- 
mediate charge;  Dr.  Robert  P.  Cooke,  a  non-im- 
mune; one  acting  hospital  steward,  an  immune; 
nine  privates  of  the  hospital  corps,  one  of  whom 
was  an  immune;  and  one  immune  ambulance 
driver. 

i'  For  the  quartering  of  this  detachment  and  of 
such  non-immune  individuals  as  should  be  received 
for  experimentation,  hospital  tents,  properly 
floored,  were  provided,  placed  at  about  twenty  feet 
apart  and  numbered  i  to  7  respectively.  Camp 
Lazear  was  established  on  November  20,  1900,  and 
from  this  date  was  put  under  strict  quarantine,  no 
one  being  permitted  to  leave  or  enter  camp,  except 
the  three  immune  members  of  the  detachment. 
Supplies  were  drawn  chiefly  from  Columbia  Bar- 
racks, and  for  this  purpose  a  conveyance  under  the 
control  of  the  immune  acting  hospital  steward,  and 
having  an  immune  driver,  was  used.  A  few  Span- 
ish immigrants,  recently  arrived  at  Havana,  were 
received  from  time  to  time,  but  a  non-immune 
person  having  once  left  the  camp  was  not  permitted 
to  return  under  any  circumstances  whatever.  The 
temperature  and  pulse  of  all  non-immune  residents 
were  carefully  recorded  three  times  daily,  so  that 
any  infected  individual  entering  the  camp  could 
be  promptly  detected  and  removed.  No  non-im- 
mune resident  was  subjected  to  inoculation  who 


138     WALTER   REED   AND  YELLOW   FEVER 

•* 

had  not  passed  in  this  camp  the  full  period  of  incu- 
bation of  yellow  fever  with  one  exception,  for 
which  there  was  a  special  reason.12 

It  was  now  proposed  [says  Dr.  Reed],  to  attempt 
the  infection  of  non-immune  individuals  in  three  dif- 
ferent ways,  namely,  first,  by  the  bites  of  mosquitoes 
which  had  previously  bitten  cases  of  yellow  fever; 
second,  by  the  injection  of  blood  taken  during  the 
early  stages  from  the  general  circulation  of  those  suf- 
fering the  disease;  and  third,  by  exposure  to  the  most 
intimate  contact  with  fomites.  For  this  purpose,  in 
addition  to  the  seven  tents  provided  for  the  quartering 
of  the  detachment,  two  frame  buildings  each  14x20 
feet  in  size  were  constructed.  These  buildings,  having 
a  capacity  of  2800  feet,  were  exactly  similar,  except  that 
one  of  them,  known  as  the  "  Infected  Mosquito  Build- 
ing," was  divided  near  the  middle  by  a  permanent 
wire  screen  partition  and  had  good  ventilation;  while 
the  other,  designated  as  the  "  Infected  Clothing  Build- 
ing," was  purposely  so  constructed  as  to  exclude  any- 
thing like  efficient  ventilation.  These  houses  were 
placed  on  opposite  sides  of  a  small  valley,  about  eighty 
yards  apart,  and  each  seventy-five  yards  distant  from 
the  camp  proper.  Both  houses  were  provided  with  wire 
screen  windows  and  double  wire  screen  doors,  so  that 
mosquitoes  could  be  kept  within  or  without  the  build- 
ings as  the  experimenters  might  desire.18 

12  "  Etiology  of  Yellow  Fever:  An  Additional  Note."    Jour. 
Amer.  Med.  Assoc.,  Feb.  16,  1901. 

13  "  Propagation  of  Yellow  Fever."    Loc.  cit. 


WORK   IN   YELLOW   FEVER  139 

The  subject  of  the  first  experiment  was  a  young 
private  from  Ohio,  named  John  R.  Kissinger,  who 
volunteered  for  the  service,  to  use  his  own  words, 
"  solely  in  the  interest  of  humanity  and  the  cause 
of  science."  When  it  became  known  among  the 
troops  that  subjects  were  needed  for  experimental 
purposes,  Kissinger,  in  company  with  another 
young  private  named  John  J.  Moran,  also  from 
Ohio,  volunteered  their  services.  Dr.  Reed  talked 
the  matter  over  with  them,  explaining  fully  the 
danger  and  suffering  involved  in  the  experiment 
should  it  be  successful,  and  then,  seeing  they  were 
determined,  he  stated  that  a  definite  money  com- 
pensation would  be  made  them.  Both  young  men 
declined  to  accept  it,  making  it,  indeed,  their  sole 
stipulation  that  they  should  receive  no  pecuniary 
reward,  whereupon  Major  Reed  touched  his  cap, 
saying  respectfully,  "Gentlemen,  I  salute  you." 
Reed's  own  words  in  his  published  account  of  the 
experiment  on  Kissinger,  are :  "  In  my  opinion 
this  exhibition  of  moral  courage  has  never  been 
surpassed  in  the  annals  of  the  Army  of  the  United 
States." 

It  should  be  mentioned  to  the  credit  of  the 
United  States  Army  that  when  men  were  needed 
for  duty  in  different  capacities  at  Camp  Lazear, 
the  number  of  volunteers  was  always  in  excess  of 
the  demand.  Subjects  for  experiment  by  inocula- 


I4o     WALTER   REED   AND   YELLOW   FEVER 

tion  or  by  exposure  to  fomites  were  always  forth- 
coming of  their  own  choice,  although  no  pains 
were  spared  by  those  in  command  to  make  them 
fully  understand  the  risks  they  assumed. 

On  December  5,  1900,  at  2  P.  M.,  five  promising 
mosquitoes  were  selected,  two  of  which  had  been 
contaminated  fifteen  days  previously;  one,  nine- 
teen days;  and  two,  twenty-two  days.  These  were 
allowed,  with  his  free  consent,  to  bite  the  patient, 
John  R.  Kissinger;  the  result  of  the  bites  was  per- 
fectly successful,  for  about  midnight  on  December 
8,  at  the  end  of  three  days,  nine  and  a  half  hours, 
the  subject,  who  had  been  under  strict  quarantine 
during  fifteen  days,  was  seized  with  a  chill  that 
proved  the  beginning  of  a  well-marked  attack  of 
yellow  fever. 

Dr.  Reed  watched  the  progress  of  this  case  with 
intense  interest,  and  wrote  to  his  wife  concerning 
it  as  follows: 

COLUMBIA  BARRACKS,  QUEMADOS,  CUBA. 

Dec.  9,  1900. 

It  is  with  a  great  deal  of  pleasure  that  I  hasten  to 
tell  you  that  we  have  succeeded  in  producing  a  case  of 
unmistakable  yellow  fever  by  the  bite  of  the  mosquito. 
Our  first  case  in  the  experimental  camp  developed  at 
11.30  last  night,  commencing  with  a  sudden  chill  fol- 
lowed by  fever.  He  had  been  bitten  at  11.30,"  Dec. 

14  Probably  a  lapsus  penna  for  2.30,  which  is  the  time 
stated  in  the  published  record. 


WORK   IN   YELLOW   FEVER  141 

5th,  and  hence  his  attack  followed  just  three  and  a  half 
days  after  the  bite.  As  he  had  been  in  our  camp  15  days 
before  being  inoculated  and  had  had  no  other  possible 
exposure,  the  case  is  as  clear  as  the  sun  at  noon-day, 
and  sustains  brilliantly  and  conclusively  our  conclu- 
sions. Thus,  just  1 8  days  from  the  time  we  began  our 
experimental  work  we  have  succeeded  in  demonstrat- 
ing this  mode  of  propagation  of  the  disease,  so  that  the 
most  doubtful  and  sceptical  must  yield.  Rejoice  with 
me,  sweetheart,  as,  aside  from  the  antitoxin  of  diph- 
theria and  Koch's  discovery  of  the  tubercle  bacillus,  it 
will  be  regarded  as  the  most  important  piece  of  work, 
scientifically,  during  the  iQth  century.  I  do  not  exag- 
gerate, and  I  could  shout  for  very  joy  that  heaven  has 
permitted  me  to  establish  this  wonderful  way  of 
propagating  yellow  fever.  It  was  Finlay's  theory,  and 
he  deserves  great  credit  for  having  suggested  it,  but  as 
he  did  nothing  to  prove  it,  it  was  rejected  by  all,  in- 
cluding General  Sternberg.  Now  we  have  put  it  be- 
yond cavil,  and  its  importance  to  Cuba  and  the  United 
States  cannot  be  estimated.  Major  Kean  says  that  the 
discovery  is  worth  more  than  the  cost  of  the  Spanish 
War,  including  lives  lost  and  money  expended.  He  is 
almost  beside  himself  with  joy  and  will  tell  General 
Wood  when  he  goes  to  town  in  the  morning.  To-mor- 
row afternoon  we  will  have  the  Havana  Board  of  Ex- 
perts, Drs.  Guiteras,  Albertini,  and  Finlay,  come  out 
and  diagnose  the  case.  I  shan't  tell  them  how  the  in- 
fection was  acquired  until  after  they  have  satisfied 
themselves  concerning  the  character  of  the  case,  then  I 
will  let  them  know.  I  suppose  that  old  Dr.  Finlay  will 
be  delighted  beyond  bounds,  as  he  will  see  his  theory 
at  last  fully  vindicated.  9.30  P.  M.  Since  writing  the 


i42     WALTER   REED   AND  YELLOW   FEVER 

above  our  patient  has  been  doing  well.  His  tempera- 
ture, which  was  102.5°  at  noon,  has  fallen  to  101°  and 
his  severe  headache  and  backache  have  subsided  consider- 
ably. Everything  points,  as  far  as  it  can  at  this  stage,  to 
a  favourable  termination,  for  which  I  feel  so  happy. 

Two  days  later  he  writes: 

Dec.  ii,  1900. 

Our  patient,  concerning  whom  I  wrote  you  in  my 
last,  is  doing  very  well.  We  had  Dr.  John  Guiteras, 
Dr.  Finlay,  and  Dr.  Albertini  out  here  to  see  him  yes- 
terday afternoon.  They  were  all  immensely  interested 
and  Dr.  Albertini  did  not  hesitate  to  say  "  yellow 
fever."  The  others  too  regarded  the  case  as  one  of 
probable  yellow  fever,  but  desired  to  see  how  his  tem- 
perature and  pulse  would  run  during  the  next  few  days. 
Dr.  Amador,  an  expert  in  yellow  fever,  says  the  dis- 
ease is  undoubtedly  yellow  fever.  Of  course,  I  can't 
blame  anyone  from  withholding  a  diagnosis  until  they 
are  satisfied,  but  from  my  standpoint  it  is  very  amus- 
ing. The  case  is  as  plain  as  the  nose  on  a  man's  face, 

but  as  Dr.  has  pronounced  in  an  interview  our 

theory  as  being  very  "  wild  and  improbable,"  of  course 
he  wants  to  be  "  let  down  easy,"  for  he  must  surrender. 
He  will  come  round  in  a  few  days.  Dr.  Gorgas  also 
saw  the  patient  and  pronounced  the  case  as  so  suspi- 
cious that  had  it  occurred  in  Havana  he  would  not 
have  hesitated  to  send  him  to  the  yellow  fever  hospital. 
Ah!  wonderful  is  nature,  and  I  thank  God  that  he  has 
allowed  poor  unworthy  me  to  look  a  little  way  into  this 
secret.  Six  months  ago,  when  we  landed  on  this  island, 
absolutely  nothing  was  known  concerning  the  propaga- 
tion and  spread  of  yellow  fever — it  was  all  an  unfath- 


WORK   IN   YELLOW  FEVER  143 

omable  mystery — but  to-day  the  curtain  has  been 
drawn — its  mode  of  propagation  is  established  and  we 
know  that  a  case  minus  mosquitoes  is  no  more  dan- 
gerous than  one  of  chills  and  fever!  Hurrah!  I  will 

write  to  Dr.  in  a  few  days  about  the  case.  Of 

course  he  will  at  once  write  an  article  to  say  that  for  20 
years  he  has  considered  the  mosquito  as  the  most  prob- 
able cause  of  yellow  fever.  That  would  be  just  in  order 

for  him  to  do.  Dr.  of  the  Marine  Service    has 

written  a  very  discourteous  reply  to  our  Preliminary 
Note  in  the  same  Journal  that  our  article  appeared 
in.  ...  Dr.  Cobb,  of  the  same  service,  has  also  writ- 
ten a  very  courteous  and  interesting  answer  to  our 
paper,  in  which  he  proves  to  his  own  satisfaction  that 
the  mosquito  can't  possibly  propagate  the  disease,  and 
says  that  it  would  be  dreadful  after  all  the  years  of  dis- 
infection that  his  service  has  done  if  this  theory  should 
be  what  we  have  claimed  for  it.  And  so  the  ball 
rolls  on!  ' 

During  the  week  following  the  onset  of  Kis- 
singer's attack  four  other  cases  of  yellow  fever  were 
produced  by  inoculation  with  mosquitoes,  and  this 
further  confirmation  of  the  mosquito  theory  had 
one  somewhat  amusing  effect,  which  Dr.  Reed 
describes  thus : 15 

It  can  readily  be  imagined  that  the  occurrence  of 
four  cases  of  yellow  fever  in  our  small  command  of 
twelve  non-immunes,  within  the  space  of  one  week, 

15  "  Propagation  of  Yellow  Fever :  Observations  Based  on 
Recent  Researches."  Loc.  cit. 


144     WALTER   REED   AND   YELLOW   FEVER 

while  giving  rise  to  feelings  of  exultation  in  the  hearts 
of  the  experimenters,  in  view  of  the  vast  importance 
attaching  to  these  results,  might  inspire  quite  other 
sentiments  in  the  bosoms  of  those  who  had  previously 
consented  to  submit  themselves  to  the  mosquito's  bite. 
In  fact,  several  of  our  good-natured  Spanish  friends, 
who  had  jokingly  compared  our  mosquitoes  to  "  the 
little  flies  that  buzzed  harmlessly  about  their  tables," 
suddenly  appeared  to  lose  all  interest  in  the  progress 
of  science,  and  forgetting  for  the  moment  even  their 
own  personal  aggrandisement,  incontinently  severed 
their  connection  with  Camp  Lazear.  Personally,  while 
lamenting,  to  some  extent,  their  departure,  I  could 
not  but  feel  that  in  placing  themselves  beyond  our 
control  they  were  exercising  the  soundest  judgment. 
In  striking  contrast  to  the  want  of  confidence  shown 
by  these  Andalusians,  who  had  agreed  to  be  bitten  by 
the  mosquitoes,  was  the  conduct  now  displayed  by 
the  three  young  Americans  who  had  consented  to 
jeopardise  their  lives  by  exposure  to  fomites,  and 
who,  as  a  matter  of  fact,  had  already  passed  fifteen 
nights  in  a  small  ill-ventilated  building,  breathing  in 
an  atmosphere  dreadfully  contaminated  by  the  soiled 
garments  of  yellow  fever  patients.  With  the  occur- 
rence of  these  cases  of  mosquito  infection  the  coun- 
tenances of  these  men,  which  had  before  borne  the 
serious  aspect  of  those  who  were  bravely  facing  an 
unseen  foe,  suddenly  took  on  the  glad  expression  of 
school-boys  let  out  for  a  holiday,  and  from  this  time 
their  contempt  for  "  fomites  "  could  not  find  sufficient 
expression.  Thus  illustrating  once  more  the  old  adage 
that  familiarity,  even  with  fomites,  may  breed  con- 
tempt ! 


WORK   IN   YELLOW   FEVER  145 

The  experiments  regarding  infection  with  fo- 
mites,  here  alluded  to,  formed  an  essential  part 
of  Dr.  Reed's  work,  since  it  was  nearly  as  im- 
portant to  establish  the  fact  that  yellow  fever  could 
not  be  conveyed  in  this  way  as  to  prove  that  it 
could  be  transmitted  by  the  mosquito.  To  show 
that  the  mosquito  was  responsible  for  the  transmis- 
sion of  yellow  fever,  without  disproving  its  con- 
veyance by  fomites,  would  only  have  added  to  the 
confusion  and  dread  with  which  the  whole  subject 
of  the  disease  was  surrounded.  For  many  years  it 
had  been  unhesitatingly  accepted  that  the  epidem- 
ics which  devastated  the  country  had  their  origin 
in  the  unpacking  of  boxes  and  trunks  containing 
infected  clothing;  hence  the  efforts  of  the  health 
authorities  were  constantly  directed  to  the  disin- 
fection of  clothing  and  bedding  from  ports  where 
yellow  fever  prevailed. 

To  determine  whether  clothing  contaminated  by 
contact  with  yellow  fever  patients  or  their  dis- 
charges really  conveyed  the  disease  from  one 
person  or  one  place  to  another  became,  therefore, 
a  matter  of  vital  importance.  If  the  mosquito 
theory  was  true,  the  fomites  theory  had  no  founda- 
tion, but  nothing  short  of  actual  demonstration  of 
its  futility  could  be  relied  on  to  induce  conviction. 

One  of  the  frame  buildings  erected  at  Camp 
Lazear  had  been  designed  for  the  special  purpose 
of  conducting  this  series  of  experiments.  It  con- 


146     WALTER   REED   AND  YELLOW   FEVER 

sisted  of  one  room,  14x20  feet  in  size,  with  two 
tiny  windows  both  facing  south,  and  closed  with 
wire  screens,  so  that  a  thorough  circulation  of  air 
was  impossible ;  in  addition  there  were  glass  sashes 
within  and  heavy  wooden  shutters  without,  the 
latter  being  intended  for  the  purpose  of  excluding 
the  sunlight.  Entrance  was  through  a  small  vesti- 
bule on  the  same  side  as  the  windows,  protected 
without  by  a  solid  door  and  divided  in  the  middle 
by  a  wire  screen  door.  The  inner  entrance  had  also 
a  screen  door,  and  in  this  way  the  entrance  of  mos- 
quitoes was  effectually  prevented.  This  house  was 
kept  closed  till  long  after  sunset  and  was  heated  to 
a  temperature  of  92°  to  95°  F.  with  precautions  to 
secure  sufficient  humidity. 

On  November  30  [says  Dr.  Reed],  the  building  being 
now  ready  for  occupation,  three  large  boxes  filled  with 
sheets,  pillowslips,  blankets,  etc.,  contaminated  by  con- 
tact with  cases  of  yellow  fever  and  their  discharges,  were 
received  and  placed  there.  The  majority  of  the  articles 
had  been  taken  from  the  beds  of  patients  sick  with  yellow 
fever  at  Las  Animas  Hospital,  Havana,  or  at  Colum- 
bia Barracks.  Many  of  them  had  been  purposely  soiled 
with  a  liberal  quantity  of  black  vomit,  urine,  and  fecal 
matter.  A  dirty  "  comfortable  "  and  much-soiled  pair 
of  blankets,  removed  from  the  bed  of  a  patient  sick 
with  yellow  fever  in  the  town  of  Quemados,  were  con- 
tained in  one  of  these  boxes.  The  same  day  at  6  P.  M. 
Dr.  Robert  P.  Cooke,  Acting  Assistant  Surgeon,  U.  S. 


CAMP    LAZEAR 

Building  where  the  experiments  were  made  which  proved  that 
yellow  fever  is  not  transmitted  by  means  of  infected  clothing 
(fomites).  The  figure  on  the  left  is  Dr.  Carroll. 


WORK   IN   YELLOW   FEVER  147 

A.,  and  two  privates  of  the  hospital  corps,  Folk  and 
Jernigan,  all  non-immune  young  Americans,  entered 
this  building  and  deliberately  unpacked  these  boxes, 
which  had  been  tightly  closed  and  locked  for  a  period 
of  two  weeks.  They  were  careful  at  the  same  time  to 
give  each  article  a  thorough  handling  and  shaking  in 
order  to  disseminate  through  the  air  of  the  room  the 
specific  agent  of  yellow  fever,  if  contained  in  these 
fomites.  These  soiled  sheets,  pillow-cases,  and  blankets 
were  used  in  preparing  the  beds  in  which  the  members 
of  the  hospital  corps  slept.  Various  soiled  articles  were 
hung  around  the  room  and  placed  about  the  bed  occu- 
pied by  Dr.  Cooke. 

From  this  date  until  December  19,  a  period  of 
twenty  days,  this  room  was  occupied  each  night  by  these 
three  non-immunes.  Each  morning  the  various  soiled 
articles  were  carefully  packed  in  the  aforesaid  boxes, 
and  at  night  again  unpacked  and  distributed  about  the 
room.  During  the  day  the  residents  of  this  house  were 
permitted  to  occupy  a  tent  pitched  in  the  immediate 
vicinity,  but  were  kept  in  strict  quarantine. 

December  12  a  fourth  box  of  clothing  and  bedding 
was  received  from  Las  Animas  Hospital.  These  arti- 
cles had  been  used  on  the  beds  of  yellow  fever  patients, 
but  in  addition  had  been  purposely  soiled  with  the 
bloody  stools  of  a  fatal  case  of  the  disease.  As  this  box 
had  been  packed  for  a  number  of  days,  when  it  was 
opened  and  unpacked  by  Dr.  Cooke  and  his  assistants 
on  December  12,  the  odour  was  so  offensive  as  to  com- 
pel them  to  retreat  from  the  house.  They  pluckily  re- 
turned, however,  within  a  short  time  and  spent  the  night 
as  usual. 


i48     WALTER    REED   AND   YELLOW   FEVER 

On  December  19  these  three  non-immunes  were 
placed  in  quarantine  for  five  days,  and  then  given  the 
liberty  of  the  camp.  All  had  remained  in  perfect  health, 
notwithstanding  their  stay  of  twenty  nights  amid  such 
unwholesome  surroundings.1* 

This  experiment  was  repeated  on  three  subse- 
quent occasions,  the  only  variation  being  that  on 
several  occasions  the  men  actually  slept  in  the  gar- 
ments used  by  yellow  fever  patients,  and  notwith- 
standing this  trying  ordeal,  they  continued  in  per- 
fect health.  There  could  be  no  doubt,  therefore, 
that  the  attempt  to  convey  the  disease  by  means  of 
fomites  was  a  total  failure,  and  if  measures  to  con- 
vey disease,  thus  carried  out,  with  every  conceiv- 
able precaution  against  its  entrance  by  other 
sources  of  infection  and  every  conceivable  facility 
for  its  admission  by  the  sources  under  considera- 
tion came  to  no  effect,  the  experiment  might  be 
accepted  as  unquestionable  evidence  that  the  dis- 
ease is  not  conveyed  by  fomites.  Dr.  Reed  writes 
to  his  wife  on  the  subject  as  follows: 

COLUMBIA  BARRACKS, 

Dec.  9,  1900. 

I  have  allowed  the  men  who  have  spent  20  nights  in 
our  infected  clothing  house  to  come  out  and  they  are 
now  in  quarantine.  Two  other  soldiers  are  now  occu- 

16  "  The  Etiology  of  Yellow  Fever."    Loc.  cit. 


WORK    IN    YELLOW   FEVER  149* 

pying  the  house  and  sleeping  not  only  in  the  same  beds 
and  between  the  same  sheets  on  which  our  yellow  fever 
patients  have  rested  during  their  attacks,  but  they  sleep 
in  the  very  shirts  that  our  patients  wore  through- 
out their  entire  illness!  If  anything  should  give  them 
the  disease  this  should  succeed!  Don't  you  think  so? 
Infected  clothing  and  bedding  have  been  a  horrible 
nightmare  during  the  past  300  years,  but,  methinks, 
it  will  die  out  very  early  in  the  next  century!  Yel- 
low fever  can  no  more  be  transmitted  in  that  way 
than  intermittent  fever.  How  General  Sternberg  and 
hosts  of  others  could  have  believed  in  the  contagious- 
ness of  clothing  and  of  the  stools  of  yellow  fever  pa- 
tients I  cannot  possibly  see.  They  were  simply  ac- 
cepting the  statements  of  others  who  had  nothing  on 
which  to  base  such  statements.  A  little  careful  testing 
of  this  theory  has  served  to  knock  it  completely  into 
smithereens.  I  thank  God  that  I  did  not  accept  any- 
body's opinion  on  this  subject,  but  determined  to  put 
it  to  a  thorough  test  with  human  beings  in  order  to  see 
what  would  happen.  My  own  observations  at  Pinar 
del  Rio  convinced  me  that  infected  bedding  was  in- 
deed a  myth.  Actual  trial  has  proven  that  I  was  right 
and  that  what  the  medical  profession  believed  was 
wrong!  ' 

It  seems  but  just  that  we  should  pause  a  moment 
here  to  commend  the  courageous  spirit  of  the  men 
who  submitted  to  the  fomites  experiments.  Dr. 
Cooke,  in  a  private  letter,  disclaims  any  credit 
for  bravery,  in  the  modest  spirit  which  has  dis- 
tinguished all  the  men  engaged  in  these  researches; 


150    WALTER    REED   AND   YELLOW   FEVER 

but,  while  it  is  true  that  the  risk  of  acquiring 
yellow  fever  in  this  way  is  absolutely  nil,  the  fact 
was  not  established  at  the  time  the  men  began 
their  sojourn  in  the  infected  clothing  building. 
Apart,  however,  from  any  question  of  possible 
yellow  fever,  surely  there  can  be  no  finer  spirit 
of  self-devotion  to  the  cause  of  science  and  of 
humanity  than  that  which  voluntarily  spends  a 
considerable  time  amid  such  repulsive  surround- 
ings. To  pass  twenty  nights  in  a  small,  ill-venti- 
lated room,  with  the  temperature  over  ninety,  in 
close  contact  with  the  most  loathsome  articles  of 
dress  and  furniture,  in  an  atmosphere  fetid  from 
their  presence,  is  an  act  of  heroism  which  ought 
to  command  our  highest  admiration  and  our  last- 
ing gratitude. 

The  non-contagiousness  of  fomites  being  thus 
definitely  settled,  the  question  arose :  How  does  a 
house  become  infected  with  yellow  fever?  and  the 
next  experiment  undertaken  was  for  the  purpose 
of  demonstrating  that  the  essential  factor  in  the 
infection  of  a  building  with  yellow  fever  is  the 
presence  of  mosquitoes  that  have  bitten  cases  of 
the  disease. 

Accordingly  [says  Dr.  Reed],17  at  11.55,  Decem- 
ber 21,  1900,  fifteen  mosquitoes  were  freed  in  the 
larger  room  of  the  "  Infected  Mosquito  Building " 

17  "  The  Propagation  of  Yellow  Fever,"  etc.    Loc.  cit. 


WORK   IN   YELLOW   FEVER  151 

which,  as  I  have  said,  was  divided  into  two  compart- 
ments by  a  wire-screen  partition.  The  interval  that  had 
elapsed  since  the  contamination  of  these  insects  was 
as  follows:  one,  twenty-four  days;  three,  twelve  days; 
four,  eight  days ;  and  seven,  five  days.  The  only  articles 
of  furniture  in  this  building  consisted  of  three  beds, 
one  being  placed  in  the  mosquito  room  and  two  beyond 
the  wire  screen,  these  latter  intended  to  be  occupied 
by  two  "  control "  non-immunes.  The  articles  of  bed- 
ding as  well  as  the  bedsteads  had  been  carefully  dis- 
infected by  steam.  At  noon  on  the  same  day,  five 
minutes  after  the  mosquitoes  had  been  placed  therein, 
a  plucky  Ohio  boy,  Moran  by  name,18  clad  only  in  his 
night-shirt  and  fresh  from  a  bath,  entered  the  room 
containing  the  mosquitoes,  where  he  lay  down  for  a 
period  of  thirty  minutes.  On  the  opposite  side  of  the 
screen  were  the  two  "  controls  "  and  one  other  non- 
immune.  Within  two  minutes  after  Moran's  entrance 
he  was  bitten  about  the  face  and  hands  by  the  insects 
that  had  promptly  settled  down  upon  him.  Seven  in  all 
bit  him  at  this  visit.  At  4.30  P.  M.  he  again  entered  and 
remained  twenty  minutes,  during  which  time  five  others 
bit  him.  The  following  day  at  4.30  P.  M.  he  again 
entered  and  remained  fifteen  minutes,  during  which 
three  insects  bit  him,  making  the  number  fifteen  that  fed 
at  these  three  visits.  The  building  was  then  closed,  ex- 
cept that  the  two  non-immune  "  controls  "  continued  to 
occupy  the  beds  on  the  non-infected  side  of  the  screen. 
On  Christmas  morning  at  1 1  A.  M.  this  brave  lad  was 

18  This  young  man,  who  volunteered  at  the  same  time  as 
Kissinger,  had  already  been  the  subject  of  one  inoculation, 
immediately  after  that  of  Kissinger.  The  results  in  his  case, 
however,  had  been  negative. 


152     WALTER   REED   AND   YELLOW   FEVER 

stricken  with  yellow  fever  and  had  a  sharp  attack  which 
he  bore  without  a  murmur.  The  period  of  incubation 
in  this  case  was  three  days  and  twenty-three  hours, 
counting  from  his  first  visit,  or  two  days  and  seventeen 
and  a  half  hours,  if  reckoned  from  his  last  visit.  The 
two  "  controls  "  who  had  slept  each  night  in  this  house, 
only  protected  by  the  wire  screen,  but  breathing  the 
common  atmosphere  of  the  building,  had  remained  in 
good  health.  They  continued  to  remain  so,  although 
required  to  sleep  here  for  thirteen  additional  nights. 
As  Moran  had  remained  in  strict  quarantine  for  the 
period  of  thirty-two  days  prior  to  his  attack,  the  source 
of  his  infection  must  be  found  in  this  house. 

WitK  this  experiment  the  work  for  the  time  be- 
ing came  to  a  close.  Dr.  Reed's  own  sentiments 
regarding  the  blessing  it  had  conferred  upon  the 
human  race  are  expressed  in  the  following  letter 
to  his  wife: 

COLUMBIA  BARRACKS, 
QUEMADOS,  CUBA, 

11.50  P.  M.,  Dec.  31,  1900. 

Only  ten  minutes  of  the  old  century  remain.  Here 
have  I  been  sitting,  reading  that  most  wonderful  book, 
"  La  Roche  on  Yellow  Fever,"  written  in  1853.  Forty- 
seven  years  later  it  has  been  permitted  to  me  and  my 
assistants  to  lift  the  impenetrable  veil  that  has  sur- 
rounded the  causation  of  this  most  wonderful,  dread- 
ful pest  of  humanity  and  to  put  it  on  a  rational  and 
scientific  basis.  I  thank  God  that  this  has  been  accom- 
plished during  the  latter  days  of  the  old  century.  May 


WORK   IN    YELLOW   FEVER  153 

its  cure  be  wrought  out  in  the  early  days  of  the  new! 
The  prayer  that  has  been  mine  for  twenty  years, 
that  I  might  be  permitted  in  some  way  or  at  some 
time  to  do  something  to  alleviate  human  suffering 
has  been  granted!  A  thousand  Happy  New  Years. 
.  .  Hark,  there  go  the  twenty-four  buglers  in 
concert,  all  sounding  "  Taps  "  for  the  old  year. 


CHAPTER  VII 
WORK   IN   YELLOW   FEVER  (CONTINUED) 

Thine  the  victory, 
As  the  just  Future  measures  gain. 

— JAMES  RUSSELL  LOWELL. 

THE  new  year  opened  auspiciously  for  the  work 
of  the  Yellow  Fever  Commission.  The  members 
felt  themselves  justified  in  stating  publicly  that 
they  had  proved  the  transmission  of  yellow  fever 
by  means  of  the  mosquito,  as  well  as  the  harmless- 
ness  of  fomites  in  conveying  the  disease;  and  they 
were  gratified  to  find  that  the  results  were  received 
with  enthusiasm  in  Havana.  Dr.  Reed  describes 
their  reception  in  a  letter  to  his  wife,  from  which 
we  have  already  quoted,  as  follows: 

COLUMBIA  BARRACKS,  CUBA, 

Dec.  23,  1900. 

Last  evening  I  attended  quite  a  swell  banquet  in 
Havana  given  to  Dr.  Finlay  by  some  seventy  or  eighty 
physicians  of  Havana.  It  was  a  very  recherche  affair 
and  extremely  enjoyable.  Everything  was  in  Spanish 
— the  Governor  General  was  there — the  toasts  were 
all  in  Spanish,  and  the  speeches,  while  flattering  to  Dr. 


WORK  IN   YELLOW   FEVER  155 

Finlay  for  his  conception  of  the  theory,  gave  us  full 
credit  for  the  discovery.  It  is  to  me  surprising  and  ex- 
tremely satisfactory  to  see  how  very  quickly  the  pro- 
fession of  Havana  have  accepted  our  results. 

The  work  of  the  Commission  was  now  nearly 
completed,  and  on  January  i,  1901,  Reed  writes: 

I  celebrated  the  day  by  writing  to  General  Stern- 
berg,  and  requesting  him  to  have  the  order  for  our  re- 
turn Issued  so  that  we  could  leave  here  the  night  after 
the  close  of  the  Pan-American  Congress.  Six  weeks 
from  to-day  I  hope  to  be  at  home  again. 

Before  leaving  Cuba,  however,  Dr.  Reed  wished 
to  investigate  some  points  of  minor  interest  associ- 
ated with  the  problems  of  moment  which  he  had 
just  solved,  namely,  whether  yellow  fever  could  be 
transmitted  by  any  other  means  than  the  bite  of  the 
mosquito,  and  what  was  the  length  of  time  during 
which  the  mosquito  was  capable  of  conveying  the 
infection.  In  order  to  determine  the  first  question 
it  was  decided  to  try  inoculation  with  the  blood  of 
a  yellow  fever  patient,  the  Commission  regarding 
it  as  probable  that  yellow  fever,  like  the  several 
types  of  malarial  fever,  might  be  produced  by  the 
injection  of  blood  taken  from  a  patient  suffering 
with  the  disease. 

The  subject  of  the  experiment  was  a  non-immune 
private,  named  Jernigan,  who  has  already  been 


156     WALTER   REED  AND  YELLOW   FEVER 

mentioned  as  one  of  those  who  slept  in  the  "  In- 
fected Clothing  Building."  He  had  been  bitten  by 
an  infected  mosquito  on  December  28  and  29,  1900, 
with  negative  results,  but  it  was  thought  that  the 
failure  of  the  experiment  might  possibly  be  due  to 
some  degree  of  natural  immunity,  or,  more  prob- 
ably, to  the  fact  that  as  most  of  the  mosquitoes  first 
used  had  been  destroyed  (presumably,  by  the  small 
red  ants  which  abounded) ,  those  by  which  Jernigan 
was  bitten  were  only  thirteen  days  old.  While  this 
matter  was  still  under  discussion,  an  opportunity 
to  make  a  good  inoculation  presented  itself,  and 
as  Jernigan  was  the  only  available  subject  in  the 
camp,  it  was  determined  to  make  use  of  him  for 
the  purpose.  He  was  accordingly  inoculated  sub- 
cutaneously  on  January  4,  1901,  with  two  cubic 
centimetres  of  blood  taken  from  the  arm  of  a  yel- 
low fever  patient  twenty-four  hours  after  the  onset 
of  the  disease ;  an  attack  of  yellow  fever  developed 
in  a  little  less  than  four  days,  showing  that  although 
the  bite  of  the  mosquito  is  the  natural  method  for 
the  transmission  of  the  disease,  it  is  not  essential. 
It  would  also  appear  that  the  mosquito  at  certain 
periods  of  the  disease  may  fail  to  obtain  the  para- 
site, a  result  not  unlike  that  sometimes  found  when 
the  blood  is  examined  in  malarial  fever.  This  first 
experiment  was  confirmed  by  three  others,  in  which 
the  subcutaneous  injection  of  blood  gave  positive 


157 

results,  the  amounts  administered  being  1.5,  0.5, 
and  i  cc.,  respectively.  Dr.  Reed's  remarks  on 
these  experiments  are  as  follows : x 

The  production  of  yellow  fever  in  this  way  is  of 
much  scientific  interest ;  first,  as  serving  to  confirm  what 
the  mosquito  inoculation  had  already  shown,  viz.,  that 
the  parasite  is  present  in  the  general  circulation;  sec- 
ond, that  passage  through  the  body  of  the  mosquito, 
although  this  would  seem  to  be  nature's  method,  ,is 
not  absolutely  necessary  in  the  life-history  of  this 
micro-organism;  and  third,  that  the  period  of  incuba- 
tion of  the  disease,  when  thus  produced,  corresponds 
fairly  closely  to  that  occasioned  by  the  mosquito's  bite. 
A  point  of  considerable  interest  brought  out  by  the 
blood  injection  was  the  absence  from  the  blood,  on 
careful  bacteriologic  culture,  of  any  bacterium  which 
grows  on  our  ordinary  media  by  anerobic  methods; 
thus  excluding  absolutely  the  bacillus  icteroides  of 
Sanarelli  from  further  claim  as  the  specific  agent  of 
yellow  fever. 

The  second  point  of  interest,  that  is,  the  number 
of  days  which  must  elapse  after  contamination  of 
the  mosquito  before  it  can  convey  the  disease  to 
a  second  individual,  was  now  taken  up. 

After  a  quarantine  period  of  nine  days  [Dr.  Reed 
says],2  a  man  named  Martinez  visited  the  room  (in 

1 "  The  Propagation  of  Yellow  Fever,"  etc.    Loc.  cit. 
2  "  The  Propagation  of  Local  Fever."    Loc.  cit. 


158     WALTER   REED   AND   YELLOW   FEVER 

which  the  mosquitoes  were  now  kept  in  jars)  and  there, 
on  December  17,  1900,  was  bitten  by  fourteen  mos- 
quitoes, which  four  days  before  had  fed  upon  the  first 
case  (Kissinger's).  The  result  was  quite  negative,  and 
on  December  24,  or  on  the  eleventh  day  after  con- 
tamination, the  subject  was  again  bitten  by  seven  of 
these  insects,  all  that  remained  of  the  original  fourteen. 
Again  no  infection  took  place.  After  six  full  days,  or 
on  December  30,  at  II  o'clock  A.  M.,  Martinez  was 
again  bitten  by  the  surviving  four  of  the  mosquitoes, 
i.  e.t  on  the  seventeenth  day  after  their  contamination. 
On  the  fourth  day  thereafter,  January  3,  1901,  at  10.30 
A.  Mv  he  was  seized  with  yellow  fever,  which  ran  a 
typical  course.  The  period  of  incubation  was  three  days 
twenty-two  and  one-half  hours.  Although  we  cannot 
say  on  what  particular  day  these  insects  became  capable 
of  conveying  the  disease,  we  are  able  to  state  that  they 
were  incapable  of  infecting  on  the  fourth  or  the 
eleventh  day  after  contamination.  These  observations 
seem  to  indicate  that  after  the  parasite  has  been  taken 
into  the  mosquito's  stomach  a  certain  number  of  days 
must  elapse  before  the  insect  is  capable  of  reconveying 
it  to  a  second  individual.  This  period  probably  repre- 
sents the  time  required  for  the  parasite  to  undergo 
its  cycle  of  development  and  reach  the  mosquito's 
salivary  glands;  and,  as  far  as  our  experience  goes,  the 
length  of  time  is  about  twelve  days  in  summer  weather, 
and  most  probably  about  eighteen  or  more  days  dur- 
ing cooler  winter  months.  The  experiment  just  given, 
therefore,  does  not  support  the  opinion  of  Finlay  that 
the  bite  of  the  contaminated  mosquito  confers  immunity 
against  a  subsequent  attack  of  the  disease,  since  we  have 


WORK   IN   YELLOW   FEVER  159 

seen  that  neither  the  bites  of  fourteen  insects  on  the 
fourth  day  nor  the  bites  of  seven  on  the  eleventh  day 
after  contamination,  prevented,  in  the  least,  the  con- 
veyance of  the  infection  by  the  bites  of  four  only  of 
these  mosquitoes  on  the  seventeenth  day. 

In  the  next  case,  the  subject,  an  immune  Ameri- 
can, was  bitten  by  insects  that  had  fed  upon  the 
first  case  (Kissinger's)  on  the  third  day  of  his 
illness,  that  is,  during  the  secondary  fever,  which  in 
this  case  followed  a  complete  intermission.  These 
mosquitoes  had  been  kept  alive  on  sugar  and  water 
for  a  period  of  thirty-nine  days  before  being  ap- 
plied to  the  case  in  question.  Of  the  original  five 
insects  that  had  bitten  Kissinger  on  the  third  day, 
four  were  still  alive  on  the  thirty-ninth  day  after- 
ward, and  three  showed  every  evidence  of  good 
appetite.  This  particular  subject,  having  passed 
twenty-one  nights  in  the  infected  clothing  build- 
ing, during  which  time  he  was  exposed  to  the  most 
intimate  contact  with  fomites  without  apparent 
detriment  to  his  health,  had  been  kept  in  strict 
quarantine  for  yet  thirty  days  longer  at  Camp  La- 
zear.  At  the  expiration  of  this  time,  on  January 
19,  1901,  at  4.30  P.  M.,  he  visited  the  mosquito- 
room,  where  he  was  bitten  by  these  thirty-nine-day- 
old  insects,  three  in  number.  This  inoculation  was 
followed  by  an  attack  of  yellow  fever  of  moderate 


160     WALTER   REED   AND   YELLOW   FEVER 

severity,  which  began  at  4  P.  M.  January  23,  the 
period  of  incubation  being  three  days  and  twenty- 
three  and  one-half  hours. 

The  next  case  [says  Dr.  Reed],8  is  of  equal  interest, 
as  the  patient  was  infected  in  the  same  room  by  the 
bites  of  two  of  these  same  mosquitoes  on  the  fifty-first 
day  after  their  contamination,  the  period  of  incubation 
being  three  days  and  two  and  one-half  hours,  and  the 
character  of  the  attack  mild;  while  still  another  case 
conclusively  demonstrates  that  these  identical  insects, 
on  the  fifty-seventh  day  after  their  contamination,  were 
not  only  capable  of  conveying  the  infection,  but  of 
producing  an  attack  of  such  severity  that  the  subject's 
life  hung  in  the  balance  for  several  days.  I  regret  to 
have  to  state  that  the  individual  who  had  consented  to 
be  bitten  by  these  insects  on  the  sixty-second  day  after 
their  contamination  failed  to  fulfil  his  promise  at  the 
last  moment;  otherwise  I  cannot  say  to  what  old  age 
these  mosquitoes  might  have  attained.  Deprived  of 
further  opportunity  to  feed  on  human  blood,  one  died 
on  the  sixty-ninth  day  and  the  other  on  the  seventy- 
first  day  after  their  original  contamination.  The  dura- 
ttion  of  life  in  the  case  of  these  mosquitoes  will  readily 
explain  how  the  poison  of  yellow  fever  can  remain 
even  in  a  depopulated  area  for  a  period  of  two  and  a 
half  months,  so  that,  as  is  well  known,  those  who  enter 
the  infected  area,  even  at  the  expiration  of  this  period, 
are  liable  to  acquire  the  disease. 

The  last  successful  case  of  mosquito  infection  at 
Camp  Lazear  was  bitten  on  February  7,  1901,  after 

3  "  The  Propagation  of  Yellow  Fever."    Loc.  cit. 


WORK   IN   YELLOW   FEVER  161 

a  period  of  twenty-five  days'  quarantine,  by  two  mos- 
quitoes, on  the  sixteenth  day  after  their  contamina- 
tion, and  was  seized  with  an  attack  of  yellow  fever  at 
noon  on  February  10,  after  an  incubation  period  of 
two  days  and  twenty-two  hours. 

These  experiments,  confirming  those  already 
mentioned  by  Carter  in  1898,  enabled  Dr.  Reed  to 
state  positively  that  at  least  twelve  days  must  elapse 
between  contamination  of  the  mosquito  by  the 
blood  of  a  yellow  fever  patient  and  the  communi- 
cation of  the  disease,  while  the  period  may  be  as 
much  as  twenty-three.  They  also  show  that  the 
mosquito  is  capable  of  conveying  the  disease  for  a 
period  of  fifty-seven  days,  and  quite  possibly 
longer. 

The  Pan-American  Congress  met  at  Havana  on 
February  4-7,  1901,  and  Dr.  Reed  submitted  before 
it  a  paper  describing  his  experiments  and  stating 
his  results.  The  points  which  he  felt  himself  justi- 
fied in  publishing  as  proved  are  these:4 

1 i )  The  mosquito,  C.  fasciatus,  serves  as  the  inter- 
mediate host  for  the  parasite  of  yellow  fever. 

(2)  Yellow  fever  is  transmitted  to  the  non-immune 
individual  by  means  of  the  bite  of  the  mosquito  that  has 
previously  fed  on  the  blood  of  those  sick  of  the  disease. 

4  "The  Etiology  of  Yellow  Fever:  An  Additional  Note." 
Jour.  Amer.  Med.  Assoc.,  Feb.  16,  1901. 


1 62     WALTER   REED   AND   YELLOW   FEVER 

(3)  An  interval  of  about  twelve  days  or  more  after 
contamination  appears  to  be  necessary  before  the  mos- 
quito is  capable  of  conveying  the  disease. 

(4)  The  bite  of  the  mosquito  at  an  earlier  period 
after  contamination  does  not  appear  to  confer  any  im- 
munity against  a  subsequent  attack. 

(5)  Yellow  fever  can  also  be  experimentally  pro- 
duced by  the   subcutaneous   injection  of  blood  taken 
from  the  general  circulation  during  the  first  and  second 
days  of  this  disease. 

(6)  An  attack  of  yellow  fever,   produced  by  the 
bite  of  the  mosquito,  confers  immunity  against  the  sub- 
sequent injection  of  the  blood  of  an  individual  suffering 
from  the  non-experimental  form  of  the  disease. 

(7)  The  period  of  incubation  in  thirteen  cases  of 
experimental  yellow  fever  has  varied  from  forty-one 
hours  to  five  days  and  seventeen  hours. 

(8)  Yellow  fever  is  not  conveyed  by  fomites,  and 
hence  disinfection  of  articles  of  clothing,  bedding,  or 
merchandise,  supposedly  contaminated  by  contact  with 
those  sick  with  this  disease,  is  unnecessary. 

(9)  A  house  may  be  said  to  be  infected  with  yellow 
fever  only  when  there  are  present  within  its  walls  con- 
taminated mosquitoes  capable  of  conveying  the  para- 
site of  this  disease. 

(10)  The  spread  of  yellow  fever  can  be  most  ef- 
fectually controlled  by  measures  directed  to  the  de- 
struction of  mosquitoes  and  the  protection  of  the  sick 
against  the  bites  of  these  insects. 

( 1 1 )  While   the  mode   of  propagation   of  yellow 
fever  has  now  been  definitely  determined,  the  specific 
cause  of  this  disease  remains  to  be  discovered. 


WORK   IN   YELLOW   FEVER  163 

Dr.  Reed's  paper  met  with  a  most  gratifying 
reception,  which  he  describes  in  a  letter  to  his 
wife,  just  before  he  sailed  for  home,  as  follows : 

COLUMBIA  BARRACKS, 

QUEMADOS, 
Feb.  6th,  1901. 

To-day  the  paper  was  read  and  met  with  a  most 
favourable  reception.  The  attention  during  the  reading 
was  all  that  I  could  have  asked  for  and  the  applause 
at  its  conclusion  long  and  hearty.  A  resolution  expres- 
sive of  the  high  appreciation  in  which  our  work  was 
held,  together  with  the  thanks  of  the  Congress,  was 
unanimously  adopted.  I  received  dozens  of  the  warm- 
est kind  of  handshakes  from  Cuban,  Spanish,  Mexi- 
can, South  American,  and  North  American  physicians, 
men  whom  I  had  not  even  met.  The  hall  was  crowded 
and  even  the  doors  packed  with  listeners.  It  was  in- 
deed a  signal  triumph  for  our  work. 

When  Dr.  Reed  returned  early  in  February, 
Dr.  Carroll  remained  behind  in  order  to  make 
some  further  observations  upon  the  blood  in  yel- 
low fever  and  also,  especially,  upon  the  urine.  The 
following  letter  was  written  him  by  Dr.  Reed 
during  this  interval : 

SURGEON  GENERAL'S  OFFICE, 

WASHINGTON,  Feb.  26,  1901. 
MY  DEAR  DOCTOR:  I  have  yours  of  the  2ist,  and 
am  afraid  that  this  will  not  reach  you  before  your  de- 
parture. I  want  you  to  bring  the  reprints  of  our  Prelimi- 


1 64    WALTER   REED   AND    YELLOW   FEVER 

nary  Note,  which  I  seem  to  have  left  behind  uninten- 
tionally. There  were  about  a  dozen  of  them.  .  .  . 

It  is  too  bad  that  would  not  take  the  bite 

again,  but  I  cannot  blame  him  after  's  expe- 
rience. Still,  10  successes  out  of  13  attempts  is  a  pretty 
good  record.  We  must  present  the  clinical  side  of  these 
cases  to  the  Association  of  American  Physicians  in  May, 
if  possible.  Neale  is  on  the  sick  list,  temporarily,  with  a 
bad  cold,  and  I  am  tied  down  to  the  Army  Examining 
Board.  Weather  still  beastly,  with  no  immediate  hope 
of  a  let-up.  You  made  no  mistake  by  remaining  in  Cuba 
till  March,  as  February  has  been  simply  atrocious. 

Give  my  love  to  everybody  and  hurry  back  as  fast 
as  you  can.  Welch,  Osier,  and  Thayer  are  very  enthu- 
siastic over  our  work.  Love  to  Agramonte  when  you 
see  him.  Sincerely  yours,  REED. 

The  specific  germ  of  yellow  fever,  however,  had 
not  yet  been  found,  and  although  its  discovery  was 
not  a  matter  of  such  vital  importance  as  the  mode 
by  which  the  disease  is  conveyed,  there  were  some 
points  connected  with  it  which  the  Commission 
desired  to  investigate  before  they  withdrew  from 
their  labours. 

Dr.  Sternberg,  who  had  always  taken  an  intense 
interest  in  the  subject,  made  the  following  pro- 
phetic suggestion  concerning  it,  on  page  531  of 
his  "  Manual  of  Bacteriology,"  published  in  1892: 

The  possibility,  of  course,  remains  that  the  specific 
infectious  agent  in  yellow  fever  may  belong  to  an  en- 


WORK   IN   YELLOW   FEVER  165 

tirely  different  class  of  micro-organisms  from  the  bac- 
teria, or  that  it  may  be  ultra-microscopic,  or  not  capable 
of  demonstration  in  the  tissues  by  the  staining  methods 
usually  employed  by  bacteriologists. 

In  the  early  summer  of  1901  Dr.  William  H. 
Welch,  of  the  Johns  Hopkins  University,  called 
Dr.  Reed's  attention  to  the  experiments  of  Loeffler 
and  Frosch,  in  which  they  had  demonstrated  that 
the  specific  infectious  agent  of  foot  and  mouth  dis- 
ease in  cattle  would  pass  through  a  porcelain  filter 
and  was,  therefore,  too  small  to  be  discovered  by 
the  microscope.  According  to  LoefHer  and  Frosch, 
there  were  two  possible  explanations  of  this  result: 
either  the  filtered  lymph  held  in  solution  an  ex- 
traordinarily active  toxin,  or  the  specific  agent  of 
the  disease  was  so  minute  as  to  pass  through  the 
pores  of  a  filter  which  prevents  the  passage  of  the 
smallest  bacteria.  They  themselves  accepted  the 
latter  explanation,  since  they  were  able  in  later 
experiments  by  means  of  the  filtered  lymph  to 
convey  the  disease  through  a  series  of  six  animals, 
the  last  of  which  sickened  just  as  promptly  after 
the  injection  of  the  filtered  lymph  as  the  first  of  the 
series.  Having  thus  determined  that  the  micro- 
organisms might  be  considered  ultra-microscopic, 
Loeffler  and  Frosch  offered  the  suggestion  that, 
perhaps,  the  specific  agent  of  some  of  the  acute 
infectious  diseases  of  man  and  the  animals,  such 


1 66    WALTER    REED    AND    YELLOW    FEVER 

as  smallpox,  scarlet  fever,  measles,  rinderpest,  etc., 
might  belong  to  the  same  category.  The  remain- 
ing members  of  the  Army  Commission,  Reed  and 
Carroll,  considered  that  investigations  carried  out 
along  the  lines  just  suggested  might  throw  light 
upon  the  aetiology  of  yellow  fever,  and  as  an  out- 
break of  the  disease  at  Santiago  de  las  Vegas,  near 
Havana,  in  the  summer  of  1901  offered  an  oppor- 
tunity of  carrying  on  the  necessary  experiments, 
Dr.  Carroll  returned  to  Cuba  for  the  purpose, 
landing  at  Havana  on  August  n,  1901.  It  was  also 
decided,  at  Dr.  Carroll's  suggestion,  to  test  the 
effect  of  moderate  temperature  upon  the  infectious 
property  of  the  serum. 

Some  months  before  Dr.  Carroll's  arrival  an 
inoculation  station  had  been  established  in  connec- 
tion with  Las  Animas  Hospital,  under  the  charge 
of  Dr.  John  Guiteras,  for  the  purpose  of  carrying 
on  inoculation  experiments.  These  experiments 
had  been  instituted,  to  use  Dr.  Guiteras'  own 
words,  "  not  with  a  view  to  control  or  confirm  the 
conclusions  of  the  United  States  Army  Commis- 
sion, for  anyone  who  has  followed  their  work  with 
unprejudiced  attention  must  have  concluded  that 
their  solution  of  the  problem  of  the  aetiology  of 
yellow  fever  was  final ;  but  rather  with  the  hope 
of  propagating  the  disease  in  a  controllable  form 
and  securing,  among  the  recently  arrived  immi- 


JAMES    CARROLL,    M.D. 

Member  of  the   U.   S.   A.  Yellow   Fever  Commission, 
photograph  taken  in  1901 


From  a 


WORK   IN   YELLOW   FEVER  167 

grants,  immunisation,  with  the  minimum  amount 
of  danger."  So  far  as  immunisation  was  concerned, 
it  may  be  said  at  once  that  the  experiments  did 
not  fulfil  the  hopes  which  had  been  based  upon 
them,  the  desired  object,  says  Dr.  Guiteras,  "  not 
being  attainable  by  the  present  methods,  without 
considerable  risk  to  the  individual." 

Up  to  the  time  of  Dr.  Carroll's  arrival  in  Ha- 
vana, Dr.  Guiteras  had  not  succeeded  in  produc- 
ing a  single  case  of  experimental  yellow  fever,  a 
fact  which  was  beginning  to  cause  him  and  his  col- 
leagues some  discouragement.  Immediately  after 
Dr.  Carroll  reached  Las  Animas  Hospital,  how- 
ever, an  experimental  case  did  develop,  and  two 
days  later  Dr.  Carroll  wrote  to  Dr.  Reed  describ- 
ing the  situation  as  follows: 

LAS  ANIMAS  HOSPITAL,  HAVANA, 

Aug.  13,  1901. 

DEAR  DOCTOR:  I  landed  on  Sunday  morning  after 
what  would  be  called  a  very  pleasant  time  as  far  as 
weather  and  sea  were  concerned,  but  I  felt  it  all  the 
same,  and  the  company  are  several  meals  ahead. 

Drs.  Finlay,  Guiteras,  and  Gorgas  were  very  much 
put  out  over  their  failures,  but  now  they  are  all  very 
much  elated.  On  the  evening  of  my  arrival  the  first  case 
came  down  on  the  fourth  day  from  four  3/19  5  insects 

5  This  was  a  formula  by  which  it  was  understood  that  the 
mosquitoes  had  bitten  a  yellow  fever  patient  on  the  third  day 
of  the  disease,  and  had  been  kept  nineteen  days  before  biting  a 
well  subject. 


168    WALTER    REED   AND   YELLOW    FEVER 

from  a  Santiago  de  las  Vegas  case.  On  the  following 
day  another  man  came  down  from  similar  insects  from 
this  case  applied  to  both  individuals  at  the  same  time. 

I  made  a  dozen  200  cc.  bouillon  flasks  at  Las  Animas 
and  am  making  preparations  to  draw  blood  from  one 
of  these  individuals  to-morrow.  .  .  . 

Everybody  is  very  nice  and  I  am  hustling  to  get 
to  work  while  the  material  is  in  sight.  Guiteras  has 
no  more  immunes  in  sight  and  some  of  his  Spaniards 
have  backed  out.  I  shall  telephone  Colonel  Havard  to 
send  me  six  subjects  from  Triscormia,  and  shall  use 
three  of  them  at  once.  In  order  to  aid  me  in  securing 
material  with  certainty,  I  have  just  asked  for  one  thou- 
sand dollars.  I  spoke  to  Colonel  Scott  about  it  this  morn- 
ing and  it  will  be  all  right.  .  .  . 

Our  friends  Bellazaghi  and  Caldos  are  located  at 
Camp  Lazear,  waiting  an  opportunity  to  demonstrate 
the  value  of  their  specific  serum.  I  learned  from  Colonel 
Havard  yesterday  that  they  claim  to  have  the  specific 
organism,  and  they  inoculate  horses  with  it  so  as  to  ob- 
tain the  serum.  They  find  it  in  black  vomit  and  in  the 
intestine  and  they  produce  yellow  fever  with  it  in  dogs ! 
Evidently  colon  or  lactis  aerogenes.  The  colonel  says 
that  they  are  willing  to  describe  the  characteristics  of 
their  organism,  but  they  have  bound  themselves  to 
some  commercial  concern,  so  that  they  cannot  furnish 
a  culture.  I  remarked  that  such  methods  of  procedure 
were  mercenary  and  unscientific,  and  if  they  believed 
they  had  the  specific  organism  they  were  in  duty  bound 
to  give  it  to  the  world,  in  order  that  their  claims  might 
be  substantiated  and  they  receive  the  credit  due  to  them 
for  such  a  valuable  piece  of  work.  A  few  drops  under 
the  skin  of  a  few  individuals  would  settle  the  point,  and 


WORK   IN   YELLOW   FEVER  169 

I  believe  they  know  it,  but  the  test  would  be  too  crucial 
for  them.  I  have  not  had  the  pleasure  of  meeting  them 
yet,  and  I  am  not  wasting  my  time  in  seeking  them. 

Major  Ross  is  exceedingly  kind  and  asks  to  be  re- 
membered. As  soon  as  I  get  any  results  I  shall  write  to 
you  again.  With  regards  to  all. 

Very  sincerely  yours, 

JAMES  CARROLL. 

Dr.  Guiteras'  satisfaction  in  his  experimental 
cases  was  soon  damped  by  the  serious  character 
that  some  of  them  assumed,  and  his  anxiety  mani- 
fested itself  in  extreme  cautiousness  as  to  permit- 
ting further  experiments  upon  his  patients,  al- 
though Dr.  Carroll  had  been  sent  to  Cuba  by  the 
United  States  Government  for  that  purpose  and 
it  was  absolutely  necessary  to  complete  his  final  in- 
vestigations that  he  should  make  them.  Dr.  Car- 
roll's next  letter  to  Dr.  Reed  describes  his  disap- 
pointment at  the  turn  affairs  were  taking. 

LAS  ANIMAS  HOSPITAL,  HAVANA, 

August  15,  1901. 

MY  DEAR  DOCTOR:  I  have  to  record  my  first  disap- 
pointment. When  I  last  wrote  you  I  was  making  prepa- 
rations to  draw  blood  from  Dr.  Guiteras'  second  case. 
It  was  a  good  one  with  a  constant  temperature  of  be- 
tween 103°  and  104°  F.,  and  I  expected  to  draw  blood 
from  him  yesterday.  Early  in  the  morning  Dr.  Guiteras 


170    WALTER    REED    AND    YELLOW   FEVER 

advised  against  it,  for  the  reason  that  the  moral  effect 
upon  the  man  might  be  bad.  He  admitted  that  the  man's 
general  condition  at  the  time  was  good,  but  he  said  that 
his  promises  to  him  did  not  include  any  such  operation. 
The  matter  was  decided  by  Major  Ross,  who  has  charge 
of  the  treatment  of  these  cases  and  who,  of  course,  sided 
with  Guiteras.  .  .  .  You  can  imagine  my  disap- 
pointment. .  .  . 

I  have  asked  for  three  men  to  bite  to-morrow  with 
the  same  insects  Dr.  Guiteras  used,  for  I  must  have 
some  good  cases.  I  expect  to  get  Spaniards  from  Tris- 
cormia.  I  have  also  asked  Colonel  Havard  for  Ames 
or  Amador  to  look  after  my  patients  while  I  am  attend- 
ing to  my  experiments.  .  .  .  With  this  arrangement 
there  will  be  no  quibbling  about  the  drawing  of  a  small 
quantity  of  blood  from  my  own  patients.  I  obtained 
half  a  dozen  insects  from  Ames  to-day,  which  his 
steward  has  been  raising,  and  I  shall  apply  them  in  the 
morning  to  the  third  case,  at  the  end  of  the  second 
day.  .  .  . 

I  receive  the  fullest  cooperation  from  General  Scott. 
The  allotment  of  $1,000  has  been  ordered  and  the 
per  diem  too.  Mr.  McCoy  has  also  called  to-day  about 
my  boxes,  which  have  not  arrived.  I  rely  upon  the 
Berkefeld  filters  and  I  have  purchased  hypodermic 
syringes  here,  so  that  I  am  equipped  for  work  in  the  ex- 
pectation of  using  these  cases.  I  am  not  deterred,  how- 
ever, and  shall  go  right  ahead.  .  .  . 

I  saw  Drs.  Bellazaghi  and  Caldos  to-day.  They  have 
injected  two  Spaniards  with  their  protective  serum,  and 
two  others  are  to  be  used  as  controls  when  the  biting 
is  done.  They  will  first  administer  another  injection  of 
what  they  call  their  vaccine.  They  say  the  immunity 


WORK   IN   YELLOW   FEVER  171 

they  confer  lasts   forty  days.   I  learn  this   from  Dr. 
Guiteras.     .     .     . 

With  kind  regards  to  everyone, 

Very  sincerely, 

JAMES  CARROLL. 

Dr.  Reed  replied  to  these  two  letters  as  follows: 

BLUE  RIDGE  SUMMIT,  PA., 

Aug.  20,  1901. 

MY  DEAR  CARROLL  :  Yesterday  I  received  your  first 
letter,  and  to-day  your  second  came.  I  am  intensely 
gratified  to  hear  that  Guiteras  and  Finlay  have  been 
able  at  last  to  confirm  our  experiments,  although  very 
sorry  to  learn  that  two  of  their  cases  are  so  severe.  It 
was  disappointing  not  to  be  permitted  to  draw  blood 
from  such  a  typical  case,  but  you  must  know  how  timid 

is  about  anything  like  a  surgical  case.     .     .     . 

Sincerely  yours, 

WALTER  REED. 

A  few  days  later  Reed  writes  again : 

BLUE  RIDGE  SUMMIT,  PA., 

Aug.  23,  1901. 

You  were  right  in  ignoring  Caldos  and  Bellazaghi. 
Think  of  reputable  physicians  stooping  to  such  unpro- 
fessional conduct!  I  am  amazed  that  did  not 

promptly  inform  the  Surgeon  General  of  the  conduct 
of  these  men. 

The  disappointment  about  the  Las  Animas  cases 
occasioned  some  delay  in  Dr.  Carroll's  observa- 
tions, for  he  was  obliged  to  produce  cases  of  ex- 


172    WALTER   REED  AND   YELLOW   FEVER 

perimental  yellow  fever  by  inoculation  of  Span- 
iards who  volunteered  for  pecuniary  reasons,  and 
then  draw  blood  for  his  further  experiments  from 
these,  instead  of  obtaining  it  without  loss  of  time, 
as  he  had  expected  to  do,  from  Dr.  Guiteras'  cases. 
I  give  a  copy  of  the  contract  used  between  the 
United  States  Government  and  the  men  who  vol- 
unteered as  subjects. 

LAS  ANIMAS  HOSPITAL,  HAVANA,  CUBA, 

Sept.  5,  1901. 

I,  Jeremiah  Tomlinson,  born  in  Lincoln,  Neb.,  de- 
clare that  I  am  twenty-five  years  of  age,  and  that  I 
have  no  one  dependent  upon  me  for  support. 

Desiring  to  become  immune  to  yellow  fever,  and  fully 
appreciating  that  in  so  doing  I  will  probably  contract 
the  disease,  I  hereby  give  my  full  and  free  consent  to 
the  inoculation  of  my  person  through  the  bites  of  mos- 
quitoes. In  consideration  of  which  I  am  to  receive  the 
sum  of  seventy-five  (75)  dollars  Am.  Cy.  if  the  inocu- 
lation fails,  and  two  hundred  (200)  dollars  if  I  contract 
yellow  fever  as  a  result  of  said  inoculation. 

JEREMIAH  TOMLINSON. 

™7.  f  R.  M.  KIRBY  SMITH, 

Witnesses  •{  ^  ^ 

(  CHARLES  PARKER. 

One  of  the  difficulties  encountered  by  Dr.  Car- 
roll at  this  time  was  associated  with  the  terms  of 
this  contract.  The  fact  that  a  sum  of  money,  no 
matter  how  small,  was  paid  to  volunteers,  whether 
they  contracted  the  disease  or  not,  induced  men 


173 

who  had  had  yellow  fever,  and  were,  therefore, 
immune,  to  present  themselves  as  subjects,  and  if 
no  one  but  the  man  himself  was  in  the  secret  he 
could  do  a  little  stroke  of  business  without  risk. 

In  spite  of  all  these  hindrances,  Dr.  Carroll  set 
to  work  with  his  customary  zeal  and  enthusiasm 
to  secure  conditions  necessary  to  the  prosecution 
of  his  researches ;  as  soon  as  suitable  cases  of  yellow 
fever  were  produced,  his  experiments  were  con- 
ducted along  the  following  lines: 

(i)  Injection  of  the  fresh  blood  taken  from  a 
vein  at  the  bend  of  the  elbow;  (2)  injection  of 
unheated  and  partially  defibrinated  blood;  (3)  in- 
jection of  partially  defibrinated  blood  heated  for 
ten  minutes  at  55°  C. ;  (4)  injection  of  diluted 
blood  serum  previously  filtered  through  a  Berke- 
feld  laboratory  filter. 

The  results  of  these  experiments  showed  that  of 
seven  individuals  who  received  subcutaneously  the 
fresh  or  partially  defibrinated  blood  in  quantities 
of  0.5  to  5  cc.,  six  (85.7  per  cent.)  developed  an 
attack  of  yellow  fever  within  the  usual  period  of 
incubation  of  the  disease,  thus  demonstrating  that 
the  specific  agent  of  yellow  fever  is  present  in  the 
blood,  at  least  during  the  first,  second,  and  third 
days  of  the  attack,  at  which  time  the  blood  em- 
ployed in  the  experiments  was  abstracted. 

It  also  appeared  that  if,  when  blood  had  been 


174    WALTER    REED    AND    YELLOW    FEVER 

injected  into  the  non-immune  subject,  additional 
blood  was  at  once  withdrawn  in  considerable  quan- 
tity and  transferred  to  tubes  of  nutritive  bouillon, 
no  organic  growth  could  be  obtained  (except  on 
one  occasion  staphylococcus  pyogenes  citreus,  a 
skin-contaminating  organism  common  in  Cuba) 
even  when  a  much  smaller  amount  injected  into 
the  individual  as  a  control  sufficed  to  produce  a 
severe  attack  of  yellow  fever. 

It  was  further  found  that  the  specific  agent  con- 
tained in  the  blood  was  destroyed,  or  at  any  rate 
attenuated,  by  heating  up  to  55°  C.  for  ten  min- 
utes, so  that  the  injection  of  1.5  cubic  centimetres 
of  the  heated  defibrinated  blood  was  harmless, 
although  the  injection  of  0.75  cubic  centimetres  of 
the  same  defibrinated  blood,  unheated,  sufficed  to 
induce  a  prompt  attack  of  yellow  fever  in  a  control 
individual. 

Of  not  less  interest  was  the  fact  brought  out  by 
these  experiments  that  yellow  fever  could  be  pro- 
duced by  the  injection  of  a  small  quantity  of  bac- 
teria— free  filtrate,  obtained  by  passing  the  diluted 
serum  through  a  Berkefeld  filter.  The  writers 
conclude  with  the  following  remarks :  6 

The  production  of  yellow  fever  by  the  injection  of 
blood  serum  that  has  previously  been  passed  through 

6  "  The  Etiology  of  Yellow  Fever :  A  Supplemental  Note." 
Amer.  Med.,  Feb.  22,  1902. 


WORK   IN   YELLOW   FEVER  175 

a  filter  capable  of  removing  all  test  of  bacteria  is,  we 
think,  a  matter  of  extreme  importance  and  interest.  The 
occurrence  of  the  disease  under  such  circumstances  and 
within  the  usual  period  of  incubation  might  be  explained 
in  one  of  two  ways,  viz.,  first,  upon  the  supposition  that 
the  serum  filtrate  contains  a  toxin  of  considerable  po- 
tency; or,  second,  that  the  specific  agent  of  yellow  fever 
is  of  such  minute  size  as  to  pass  readily  through  the 
pores  of  a  Berkefeld  filter. 

In  favour  of  the  supposition  that  in  yellow  fever  an 
active  toxin  is  present  in  the  blood,  may  be  cited  the 
early  and  marked  jaundice;  the  free  haemorrhage  from 
the  mucous  membrane  of  the  mouth  and  stomach,  doubt- 
less due  to  profound  changes  in  the  capillary  vessel- 
walls;  the  rapid  progress  of  the  disease  to  a  fatal  ter- 
mination, the  advanced  fatty  degeneration  of  the  hepatic 
cells,  as  well  as  the  marked  parenchymatous  changes 
found  in  the  kidneys.  If  present  in  the  blood,  this  toxin 
would  in  all  likelihood  be  found  in  the  serum  filtrate  ob- 
tained from  the  blood,  and  if  injected  in  sufficient  quan- 
tity might  induce  an  attack  of  yellow  fever  in  a  sus- 
ceptible individual  after  the  usual  period  of  incubation. 
In  this  respect  it  would  bear  analogy  to  the  production 
of  tetanus  in  the  human  being,  after  the  usual  period  of 
incubation  of  this  disease,  by  the  subcutaneous  injection 
of  a  very  small  quantity  of  tetanus  toxin,  as  reported  by 
Nicolas,  in  1893,  and  more  recently  by  Bolton,  Fisch, 
and  Walden. 

Against  the  view  that  a  toxin  is  present  in  the  serum 
filtrate,  we  invite  attention  to  the  innocuousness  of  the 
partially  defibrinated  blood  when  heated  to  55°  C.  for 
ten  minutes.  .  .  .  Here  the  toxin,  which  must  have 
been  present  in  just  the  same  quantity  as  in  the  serum 


176    WALTER    REED   AND    YELLOW   FEVER 

filtrate  obtained  from  this  blood,  appears  to  have  been 
completely  destroyed  by  the  temperature  above  men- 
tioned. Now,  although  certain  bacteria  are  destroyed 
by  this  temperature,  as  yet  we  know  of  no  bacteria  toxin 
that  is  rendered  inert  by  such  a  low  degree  of  heat  con- 
tinued for  such  a  short  time.  .  .  .  The  tetanus  toxin 
which  has  been  found  to  be  the  most  sensitive  thus  far, 
requires,  according  to  Kitasato,7  a  temperature  of  60° 
C.  for  twenty  minutes,  or  55°  C.  for  one  and  one  half 
hours,  in  order  to  destroy  its  activity. 

As  a  further  test,  and  in  order  to  determine  whether 
the  serum  filtrate  contained  something  more  particu- 
late  than  a  soluble  toxin,  we  availed  ourselves  of  the 
opportunity  of  observing  the  effect  that  would  follow 
the  transference  to  a  third  individual  of  blood  drawn 
from  one  of  the  patients  whose  attack  had  been  oc- 
casioned by  the  injection  of  1.5  cc.  of  serum  filtrate.  If 
under  these  circumstances  it  should  be  found  that  the 
injection  of  a  small  amount  of  blood  was  followed  by  an 
attack  of  yellow  fever  in  a  third  individual,  the  evidence 
would  point  in  the  strongest  manner  to  the  presence  of 
the  disease  in  such  blood,  since  we  can  hardly  believe 
that  a  toxin  which  had  undergone  so  great  dilution  in 
the  body  of  the  second  individual  would  still  be  capable 
of  producing  the  disease. 

The  patient  who  submitted  to  inoculation  for 
the  purpose  of  determining  this  crucial  point  was 
a  young  American  non-immune,  mentioned  in  the 
report  simply  as  J.  M.  B.  He  was  injected  with 

7  The  distinguished  Japanese  bacteriologist. 


177 

1.5  cc.  of  serum  filtrate,  and  then,  at  the  beginning 
of  the  eighth  day  after  his  first  inoculation,  was 
given  a  subcutaneous  injection  of  1.5  cc.  of  blood 
drawn  from  the  venous  circulation  of  a  patient  in 
whom  the  disease  had  followed  the  injection  of 
3  cc.  of  serum  filtrate,  representing  1.5  cc.  of  the 
undiluted  serum.  At  the  time  of  the  inoculation 
the  subject's  condition  was  quite  normal.  After  an 
inoculation  of  just  twenty-four  hours  he  developed 
a  well-marked  case  of  yellow  fever,  which  ran  a 
typical  course  and  ended  in  prompt  recovery.  The 
incubation  period  of  yellow  fever  in  cases  induced 
by  the  bite  of  the  mosquito  had  been  shown  by 
Reed  and  by  Guiteras  to  vary  from  six  days  one 
hour,  in  the  longest  case,  to  two  days  thirteen 
hours,  in  the  shortest;  while  in  cases  produced  by 
the  injection  of  blood  it  varied  from  five  days  two 
hours  to  one  day  seventeen  hours.  "  In  view  of  this 
data,"  Reed  and  Carroll  remark,  "  we  believe  that 
we  are  justified  in  expressing  the  opinion  that  the 
source  of  infection  in  the  case  just  described  must 
be  attributed  to  the  injection  of  blood  rather  than 
to  the  injection  of  filtered  serum  derived  from  the 
blood,  and,  further,  that  the  blood  contained  the 
specific  agent  of  yellow  fever,  which  had,  there- 
fore, passed  through  the  filter  along  with  the  fil- 
trate with  which  the  individual  in  this  case  had 
been  inoculated." 


178    WALTER   REED   AND   YELLOW   FEVER 

During  the  experiments  conducted  by  Dr.  Car- 
roll at  this  time  an  incident  occurred  which  is  an 
apt  illustration  of  the  disappointments  and  failures 
liable  to  overtake  scientific  investigators  at  all 
times,  even  though  every  source  of  disaster  has, 
apparently,  been  guarded  against.  I  give  Dr.  Car- 
roll's account  of  it  in  full : 

LAS  ANIMAS  HOSPITAL,  HAVANA, 

Sept.  24,  1901. 

MY  DEAR  DOCTOR:  I  have  a  beautiful  case  now  on 

hand,   and  if  had  obeyed  orders  the  serum  test 

would  have  been  made.  It  is  a  pronounced  case,  but 
appears  to  be  doing  well. 

Well,  on  Saturday  morning  I  drove  over  to  Santa 
Clara  Battery,  and  arranged  for  my  three  men  for  this 
evening.  From  there  I  went  to  Quemados,  drew  more 
blood,  made  a  few  smears,  examined  fresh  blood  and 
urine,  and  applied  mosquitoes.  By  2  P.  M.  the  serum 
had  separated  well  (six  hours),  and  was  transferred 
with  a  pipette  to  a  test-tube,  both  being  sterile.  After 
dinner  at  Las  Animas  I  proceeded  to  the  laboratory 
to  filter  it.  My  pump  had  been  tested  and  found  to 

work  perfectly,  and was  directed  to  place  it  under 

lock  and  key  and  not  to  allow  any  person  to  interfere 
with  it.  A  closet  of  large  size  was  available,  and  only 
he  and  I  had  keys  to  it. 

It  was  already  dark  and  I  was  working  by  gaslight, 
and  as  I  had  promised  to  come  for  the  men  at  7  P.  M. 
I  had  no  time  to  lose  in  order  to  inject  the  filtrate  that 
night.  I  took  it  for  granted  that  the  pump  had  not  been 
disturbed,  but  after  the  first  few  strokes  the  filter  was 


WORK   IN   YELLOW   FEVER  179 

forced  out  of  the  flask  ( was  holding  both)  with 

considerable  force,  fell  on  the  table,  and  was  broken, 
losing  all  the  serum !  The  valve  attachment  of  the  pump 
had  been  reversed,  so  that  a  positive  instead  of  a  nega- 
tive pressure  was  obtained,  with  the  result  stated.  The 
valve  attachment  was  easily  reversible,  but  I  had  made 
it  a  point  never  to  change  it  since  I  saw  it  work  in  the 

store  in  New  York. had  evidently  unscrewed  the 

thing,  and  replaced  it  in  the  same  position,  as  he 
thought.  There  was  nothing  on  the  outside  to  indicate 
the  position  of  the  pump  valve,  which  he  thought  was 
in  the  plunger  of  the  pump.  Instead,  it  is  screwed  in  as 
a  separate  piece  between  the  nozzle  and  the  barrel.  As 
the  heavy  pressure  tubing  remained  tied  to  the  nozzle, 
there  was  no  reason  to  suppose  it  had  been  disturbed, 
but  I  did  notice  that  instead  of  taking  the  pump  from 
the  closet  that  was  locked,  he.  took  it  from  the  adjoin- 
ing one,  which  was  not  locked.  This  leads  me  to  believe 
that  in  his  confidence  in  his  mechanical  ability  he  had 
taken  the  thing  apart  to  show  some  one,  and  had  neg- 
lected to  return  it  to  its  proper  compartment. 

I  had  tested  the  outfit  a  number  of  times,  and  it  had 
never  failed  to  work  perfectly,  generating  a  tremendous 

pressure. denies    absolutely    any   knowledge    of 

manipulation,  but  subsequent  events  prove  him  to  be 
a  ready  liar.  I  had  directed  him  a  number  of  times  to 
say  nothing  to  any  person  about  the  work,  or  anything 
connected  with  it.  This  morning  I  met  Dr.  Guiteras, 
and  told  him  I  had  a  case  at  last.  He  replied :  "  Yes,  so 
I  hear.  It  was  too  bad  that  you  had  an  accident  with 

your  serum. says  that  there  was  too  much  vaseline 

on  the  plunger,  and  it  clogged  the  valve !  " denied 

having  spoken  a  word,  but  I  convinced  him  that  I  knew 


i8o    WALTER  REED  AND  YELLOW  FEVER 

better,  and  advised  him  if  he  valued  his  job  to  keep  his 
mouth  closed.  I  have  been  keeping  as  dumb  as  an  oyster 
while  he  has  been  keeping  people  posted  on  my  work! 


To  this  letter  Reed  replied:  "I  should  have 

been  tempted  to  have  dynamited had  I  been 

there.  It  only  goes  to  show  that  you  cannot  trust 
anybody! " 

With  these  experiments  of  Dr.  Carroll's  at  Las 
Animas  the  business  of  the  Army  Commission 
came  to  an  end,  and  Dr.  Reed's  own  active  work 
in  yellow  fever  ceased,  although  his  interest  in  the 
subject  continued  unchanged  during  the  remain- 
der of  his  life.  The  results  obtained  by  Dr.  Carroll 
were  embodied  by  the  Commission  in  a  paper  pre- 
sented to  the  Society  of  American  Bacteriologists 
when  it  met  at  Chicago  at  the  close  of  the  year 
1901,  which  was  published  in  American  Medicine 
for  February  22,  1902,  under  the  title,  "The  Eti- 
ology of  Yellow  Fever:  A  Supplemental  Note." 
This  was  the  last  publication  issued  in  the  name  of 
the  Commission,  but  some  other  interesting  papers 
on  the  subject  were  published  later  by  Dr.  Carroll, 
and  will  be  discussed  elsewhere. 

Before  concluding  this  chapter,  a  word  must  be 
said  concerning  the  debt  which  the  world  owes  to 
Major-General  Leonard  Wood,  the  Military  Gov- 
ernor of  Cuba,  for  his  active  and  intelligent  inter- 


WORK   IN   YELLOW   FEVER  181 

est  in  the  work  of  the  Army  Commission.  When 
application  was  made  to  General  Wood  for  per- 
mission to  conduct  experiments  on  non-immune 
persons,  together  with  a  request  for  a  liberal  sup- 
ply of  money  to  be  expended  in  rewarding  volun- 
teers who  should  submit  themselves  to  experiment, 
both  money  and  authority  were  liberally  granted. 
It  was  most  fortunate  for  the  work  that  General 
Wood  was  not  only  a  man  of  sound  judgment  and 
extended  sympathies,  but  that  his  scientific  train- 
ing enabled  him  to  comprehend  the  nature  of  the 
experiments  which  Dr.  Reed  proposed  to  under- 
take, and  to  appreciate  their  value  to  the  world  at 
large. 

Dr.  Reed,  in  making  acknowledgment  of  Gen- 
eral Wood's  kindness,  says :  "  Without  his  ap- 
proval and  assistance  these  observations  could  not 
have  been  carried  out."  But,  even  more  than  this : 
had  the  head  of  affairs  in  Cuba  been  a  man  of 
less  intelligence,  less  breadth,  or  less  knowledge, 
the  work  might,  and  probably  would,  have  been 
far  less  fruitful  of  benefit  to  humanity.  Wherever 
the  recent  discoveries  concerning  yellow  fever  are 
known,  and  protective  measures  based  upon  them 
are  employed  for  the  safety  of  communities,  Gen- 
eral Wood's  hearty  support  of  Major  Reed  and 
his  colleagues  should  be  remembered  with  respect 
and  gratitude. 


CHAPTER  VIII 

PRACTICAL  APPLICATION  OF  THE  MOSQUITO 
THEORY  OF  YELLOW  FEVER 

Disease  and  her  ravening  offspring,  Pain  with  the  thousand 

teeth, 

He  drave  into  night  primeval,  the  nethermost  worlds  beneath. 
— WILLIAM  WATSON,  The  Dream  of  Man. 

LET  us  now  consider  for  a  moment  the  practical 
results  of  Dr.  Reed's  discovery;  in  other  words,  let 
us  ascertain  whether  a  town  or  district  can  actually 
be  freed  from  yellow  fever,  or  protected  against  its 
invasion,  by  the  use  of  methods  based  on  the  theory 
of  mosquito  inoculation.  And,  if  so,  what  are  these 
methods  in  detail? 

The  best  answer  to  the  first  of  these  questions 
will  be  found  in  Dr.  Reed's  own  account  of  the 
results  of  his  theory  when  put  into  practice  in  the 
city  of  Havana,  published  in  the  Journal  of  Hy- 
giene for  April,  1902: 

The  importance  of  the  discovery  that  yellow  fever  is 
transmitted  by  the  bite  of  a  certain  species  of  mosquito 
did  not  fail  to  attract  the  prompt  attention  of  the  mili- 
tary governor  of  Cuba,  himself  a  physician,  and  for- 

182 


MOSQUITO   THEORY  OF   YELLOW  FEVER    183 

merly  a  distinguished  member  of  the  Medical  Depart- 
ment of  the  United  States  Army.  By  his  direction  the 
theory  was  subjected  to  a  practical  test  in  the  city  of 
Havana,  in  which  city  yellow  fever  had  not  failed  to 
make  its  yearly  appearance  during  the  past  one  hundred 
and  forty  years. 

Under  the  efficient  management  of  the  chief  officer, 
Surgeon-Major  William  Gorgas,  U.  S.  A.,  the  sanitary 
regulations  were  so  far  modified  as  to  require  that 
every  patient  having  yellow  fever  should  not  only  be 
quarantined,  but  that  his  room  should  be  promptly 
protected  with  wire  screens,  so  as  to  prevent  the  pos- 
sibility of  mosquitoes  becoming  infected  by  sucking  the 
blood  of  the  patient.  As  a  second  important  measure, 
a  systematic  destruction  of  all  mosquitoes  in  other 
rooms  of  the  patient's  house,  as  well  as  in  adjoin- 
ing houses,  was  at  once  begun,  the  fumes  of  pyre- 
thrum  being  relied  upon  to  stupefy  the  insects,  after 
which  they  were  carefully  swept  up  and  buried.  In 
other  words,  Surgeon-Major  Gorgas,  relying  upon  the 
well-known  slow  progress  of  yellow-fever,  sought  to 
destroy  all  mosquitoes,  infected  or  non-infected,  within 
a  given  radius  of  each  case,  while  at  the  same  time 
he  effectually  excluded  all  mosquitoes  from  access  to 
the  sick.  If  a  secondary  case  occurred,  the  same 
hygienic  measures  were  vigorously  enforced  along  the 
lines  indicated. 

As  an  illustration  of  what  has  been  accomplished  by 
these  newer  sanitary  regulations,  I  may  say  that,  count- 
ing from  the  date  when  they  were  put  into  force,  viz., 
February  15,  1901,  Havana  was  freed  from  yellow 
fever  within  ninety  days;  so  that  from  May  7  to  July 
i,  a  period  of  fifty- four  days,  no  cases  occurred.  Not- 


184     WALTER  REED  AND  YELLOW   FEVER 

withstanding  the  fact  that  on  the  latter  date  and  dur- 
ing the  months  of  July,  August,  and  September,  the 
disease  was  repeatedly  reintroduced  into  Havana  from 
an  inland  town,  no  difficulty  was  encountered  in 
promptly  stamping  it  out  by  the  same  measures  of  sani- 
tation, intelligently  applied,  both  in  the  city  of  Havana 
and  in  the  town  of  Santiago  de  las  Vegas,  whence  the 
disease  was  being  brought  into  Havana. 

As  a  further  illustration  of  the  remarkable  sanitary 
victory  accomplished  over  a  disease  whose  progress  we 
have  heretofore  been  powerless  to  arrest,  I  will  close 
this  paper  by  inviting  the  reader's  attention  first  to  the 
accompanying  Chart  I.,  which  shows  the  average  mor- 
tality from  yellow  fever  in  Havana  for  the  twenty 
years  1880-1899,  inclusive,  and  also  the  mortality  by 
month  for  the  years  1900  and  1901.  I  will  then  ask 
him  to  examine  Chart  II.,  which  shows  the  progress 
of  yellow  fever  in  Havana  during  the  epidemic  year 
ending  March  I,  1901,  when  the  sanitary  authorities 
were  putting  forth  every  effort  known  at  the  time  to 
sanitary  science  in  order  to  control  the  march  of  the 
disease,  and  when  he  has  satisfied  himself  that  no  effect 
whatever  was  produced  upon  the  epidemic  of  that 
year,  I  will  invite  his  attention  to  Chart  III.,  which 
shows  the  occurrence  of  that  disease  in  Havana  for  the 
epidemic  year  March  i,  1901,  to  March  i,  1902,  dur- 
ing which  year  yellow  fever  was  fought  on  the  theory 
that  the  specific  agent  of  this  disease  is  transmitted 
solely  by  means  of  the  bites  of  infected  mosquitoes. 
By  carefully  comparing  the  figures  both  as  to  deaths 
and  cases  in  these  two  charts,  and  recalling  that  be- 
tween the  years  1853  and  1900  there  have  been  re- 
corded in  the  city  of  Havana  35,952  deaths  from  yel- 


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i86     WALTER   REED   AND   YELLOW   FEVER 

low  fever,  he  will  then  be  able  to  more  clearly  appre- 
ciate the  value  of  the  work  accomplished  by  the  Ameri- 
can Army  Commission. 


CHART  II. — Shows  the  progress  of  yellow  fever  in  Havana  during 
the  epidemic  year  ending  March  i,  1901,  when  the  Sanitary  authorities 
were  putting  forth  every  effort  known  to  sanitary  science  in  order 
to  control  the  disease.  The  unbroken  line  shows  the  number  of  cases, 
while  the  broken  line  gives  the  mortality.  This  also  was  in  the  pre- 
mosquito  period. 


MOSQUITO   THEORY   OF  YELLOW  FEVER     187 

To  this  statement  Major  J.  R.  Kean,  who  used 
the  paper  in  a  somewhat  abridged  form  after  Dr. 
Reed's  death,  adds  the  following  footnote: 

Not  a  single  case  of  yellow  fever  occurred  in  Ha- 
vana during  the  year  1902,  nor,  so  far  as  known,  in  the 
Island  of  Cuba.— J.  R.  K. 

.These  facts  speak  for  themselves,  but  a  more 
detailed  demonstration  of  the  practical  value  of 


CHART  III. — Shows  the  occurrence  of  yellow  fever  in  Havana  for 
the  epidemic  year  March  i,  1901,  to  March  i,  1902,  during  which  year 
yellow  fever  was  fought  on  the  theory  that  the  specific  agent  of  the 
disease  is  transmitted  by  means  of  infected  mosquitoes.  Note  the 
extraordinary  contrast  between  Chart  III,  under  the  new  regime,  and 
Charts  I  and  II,  under  the  old. 

Dr.  Reed's  theory  is  given  in  the  results  obtained 
by  Dr.  G.  M.  Guiteras,  in  1903,  at  Laredo,  Texas. 
Dr.  Guiteras's  work  also  affords  an  interesting  in- 
sight into  the  details  of  the  method  by  which  disin- 
fection based  on  the  mosquito  theory  is  carried  out, 


1 88     WALTER   REED   AND   YELLOW   FEVER 

and  shows  that  the  desired  end  can  be  attained 
under  adverse  conditions,  such  as  were  present  in 
Laredo,  as  well  as  under  the  favourable  circum- 
stances which  obtained  in  Havana. 

In  1903  Dr.  Guiteras  was  appointed  by  the  Sur- 
geon-General to  investigate  the  epidemic  at  La- 
redo, a  town  of  18,000  inhabitants,  and  he  arrived 
there  on  September  25,  1903,  in  company  with 
Dr.  George  R.  Tabor,  State  health  officer  of  Texas. 
On  their  arrival  they  found  that  yellow  fever  had 
already  obtained  a  firm  foothold  and  was  widely 
disseminated  in  a  population  consisting  almost  en- 
tirely of  non-immunes;  it  was  also  firmly  estab- 
lished in  the  little  neighbouring  town  of  Nuevo 
Laredo,  containing  about  8000  inhabitants,  and 
separated  from  Laredo  itself  by  the  River  Rio 
Grande,  over  which  there  are  various  avenues  of 
communication.  There  was  reason  to  believe  that 
the  disease  had  been  imported  directly  from  Mon- 
terey, having  originally  come  from  Tampico,  Mex- 
ico, along  the  line  of  the  Mexican  National 
Railroad. 

On  investigation  it  was  found  that  the  stegomyia 
fas  data  was  present  in  enormous  quantities  and 
widely  distributed,  the  conditions  of  the  water  sup- 
ply being  such  as  to  afford  every  facility  for  its 
active  propagation.  A  private  water-works  com- 
pany supplied  both  towns,  but  as  its  rates  were  too 


MOSQUITO  THEORY   OF  YELLOW  FEVER     189 

high  for  the  poorer  classes,  the  latter  were  in  the 
habit  of  buying  water  from  carts  driven  along  the 
streets,  which  obtained  their  supply  directly  from 
the  river.  The  water  from  both  sources  was  so 
muddy  that  it  was  the  universal  custom  to  use  bar- 
rels as  receptacles,  for  the  purpose  of  allowing  the 
water  to  settle.  Every  house  was  supplied  with 
from  one  to  ten  of  these  water-casks,  which,  as  a 
matter  of  course,  were  kept  in  sheds  or  dark  and 
shady  corners.  As  Dr.  Guiteras  says,  it  would  be 
difficult  to  improve  on  them  as  breeding  places 
for  mosquitoes.  The  houses  of  the  poorer  classes 
were  of  the  worst  type,  many  of  them  being  simply 
adobe  huts  with  thatched  roofs,  which  consist  of 
one  room,  and  possibly  a  shed  at  the  back,  used  for 
a  kitchen.  Others  are  made  of  lumber,  with  no 
attempt  at  apposition  between  the  planks,  and  oth- 
ers again  are  partly  or  wholly  constructed  of  tin  or 
of  iron,  with  just  enough  lumber  to  attach  these 
thereto. 

On  the  26th  of  September  [says  Dr.  Guiteras],1  an 
office  was  established  in  the  central  part  of  the  city  for 
the  transaction  of  business  and  on  the  following  day  the 
sanitary  corps  under  my  command  was  given  a  definite 
organisation.  Four  mosquito  sections  had  been  formed, 
with  an  acting  assistant  surgeon  in  charge  of  each, 

1  "  The  Yellow  Fever  Epidemic  of  1903,  at  Laredo,  Texas." 
Jour.  Amer.  Med.  Assoc.,  July  9,  1904. 


igo     WALTER   REED   AND   YELLOW   FEVER 

and  Past  Assistant-Surgeon  Von  Ezdorf  given  general 
supervision  over  the  entire  squad.  Each  section  con- 
sisted of  about  eight  men,  one  of  whom  was  a  car- 
penter, and  another  was  designated  as  foreman  and  had 
charge  of  the  material.  Each  section  was  supplied  with 
a  cart  containing  all  the  material  necessary  for  the  work, 
to  wit:  Sulphur  and  pyrethrum  powder  in  sufficient 
quantity,  twenty-five  pots,  twenty-five  pans,  five-gallon 
can  of  wood  alcohol,  roll  of  paper,  shears,  knives, 
bucket  of  paste,  brushes,  brooms,  wall-brushes,  mos- 
quito netting,  a  number  of  strips  of  lath,  nails,  hatchet, 
saw,  ready-made  screen  doors  and  windows,  ladder, 
five-gallon  can  of  kerosene  oil. 

Within  a  short  time  the  above  system  was  somewhat 
modified,  with  the  object  of  gaining  time  and  effective- 
ness. The  carpenters  were  separated  from  the  general 
disinfecting  section  and  formed  at  first  into  two  and 
later  into  three  "  screening  "  sections.  These  were  com- 
posed each  of  two  or  three  carpenters,  supplied  with 
a  wagon  carrying  tools,  lumber,  mosquito  bars,  and 
mosquito  netting.  The  modus  operandi  was  then  as 
follows : 

Immediately  on  a  case  (whether  suspicious  or  positive") 
being  reported  to  us  by  the  state  board  of  health  or  by 
anyone  having  authority  to  do  so,  a  screening  section 
was  at  once  sent  out  and  the  infected  house  "  screened." 
This  "  screening  "  varied  according  to  circumstances. 
Unnecessary  doors  and  windows  were  shut  tight.  One 
window  and  a  door  of  the  patient's  room  were  left  open 
for  ventilation  and  to  admit  those  caring  for  him, 
and  both  of  these  were  fitted  with  wire  screens.  Often 
the  conditions  did  not  admit  of  this.  The  shacks  or 
"  jacals  "  of  the  poorer  classes  consisted  of  but  one  room 


MOSQUITOES 

The  lower  left-hand  figure  is  the  adult  male   yellow  fever  mosquito. 

The  middle  lower  figure  is  the  adult  female  yellow  fever  mosquito,  by 
means  of  which  the  disease  is  transmitted. 

The  lower  right-hand  figure  shows  the  male  yellow  fever  mosquito,  from 
the  side. 

The  two  upper  right-hand  figures  are  the  male  and  female  (male  to  the  left) 
of  the  Anopheles  maculipennis — the  malarial  mosquito. 

The  left-hand  upper  figure  shows  the  Culex  sollicitans,  the  common  Atlantic 
coast  ring-legged  mosquito. 

These  figures  are  used  by  the  courtesy  of  L.  O.  Howard,  Ph.D. 


MOSQUITO   THEORY    OF   YELLQW   FEVER     191 

with  innumerable  openings  in  the  walls  and  rooms. 
Screening  was  impracticable  here,  and  the  patient  was 
placed  under  a  mosquito  bar.  Towards  the  end  of  the 
epidemic  I  had  a  portable  mosquito  house  built,  cov- 
ered with  wire  gauze  and  with  double  doors,  which 
was  applicable  to  such  cases.  The  patient  being  thus 
isolated  and  rendered  as  safe  as  possible  against  pro- 
pagating the  disease  by  infecting  the  mosquito,  the 
disinfecting  section  would  come  along  and  disinfect  the 
premises  and  surrounding  houses  to  kill  the  insects 
already  infected.  It  was  also  the  duty  of  the  disinfect- 
ing section  to  pour  oil  into  all  cisterns,  barrels,  or  other 
receptacles  of  stagnant  waters  found  on  the  premises 
disinfected. 

The  details  of  the  disinfecting  process  were  as  fol- 
lows :  The  room  or  house  was  made  mosquito-tight.  To 
accomplish  this,  all  doors  and  windows  were  closed. 
Paper  was  then  cut  into  strips  and  pasted  over  all  cracks 
or  openings  through  which  mosquitoes  might  escape ;  the 
chimney  was  made  secure.  In  many  cases  houses  were  in 
such  bad  condition  that  they  had  to  be  almost  completely 
papered  over,  both  inside  and  out,  and  large  unprotected 
openings  covered  entirely  with  sheets  of  paper.  In  the 
meantime  the  pots  were  being  filled  with  sulphur  or 
pyrethrum,  as  the  case  might  demand,  and  placed  in 
position  on  pans  filled  with  water.  These  water-pans 
served  a  double  purpose,  to  prevent  danger  from  fire 
and  for  the  purpose  of  collecting  mosquitoes,  for  ex- 
perience had  shown  that  after  disinfection  nearly  all  the 
dead  mosquitoes  within  the  room  were  found  in  the 
pans.  .  .  . 

The  pots  and  pans  being  in  position,  about  fifty  cubic 
centimetres  of  alcohol  were  poured  on  the  sulphur, 


192     WALTER   REED   AND  YELLOW   FEVER 

or  pyrethrum,  as  the  case  might  be,  and  the  contents 
ignited.  Then,  without  loss  of  time,  the  disinfectors 
would  retire,  closing  the  last  door  of  exit  and  pasting 
paper  over  any  cracks  that  might  be  found  in  it.  When 
the  house  admitted  of  it,  all  rooms  except  that  of  the 
patient  were  first  disinfected,  and  he  was  then  removed 
to  one  of  the  disinfected  rooms,  duly  protected  from 
mosquitoes,  so  as  to  permit  of  the  disinfection  of  the 
room  occupied  by  him.  .  .  .  For  the  purpose  of  mos- 
quito disinfection,  sulphur  was  burned  in  the  propor- 
tion of  four  pounds  to  the  one  thousand  cubic  feet, 
with  four  hours'  exposure ;  pyrethrum,  six  pounds  to  the 
one  thousand  cubic  feet,  with  six  hours'  exposure.  On 
the  termination  of  the  disinfection  the  house  was  opened 
and  the  floors,  walls,  furniture,  etc.,  carefully  swept  for 
the  purpose  of  collecting  all  asphyxiated  mosquitoes 
and  immediately  incinerating  them.  .  .  . 

The  above  plan  was  adhered  to  until  the  end  of  the 
epidemic,  with  the  modification  that  the  duties  of  oiling 
cisterns,  barrels,  and  receptacles  of  all  kinds  assumed 
such  proportions  that  on  October  9  an  oiling  section  was 
organised  and  set  to  work.  This  section  was  put  in 
charge  of  Acting  Assistant-Surgeon  Frick,  with  a  wagon 
carrying  the  necessary  material.  Subsequently  it  was 
divided  into  two  sections,  one  attending  to  the  sprinkling 
of  the  streets,  pools,  ponds,  and  other  large  bodies  of 
standing  water;  the  other  looking  after  water-barrels, 
cisterns,  pails,  tin  cans,  and  all  other  water  containers 
found  in  the  neighbourhood  of  houses. 

Naturally  much  opposition  arose  against  the  oiling  of 
the  water-barrels,  especially  among  the  ignorant  classes, 
who  were  led  to  believe  that  our  object  was  to  poison 
the  water.  On  several  occasions  this  opposition  assumed 


MOSQUITO   THEORY   OF  YELLOW  FEVER     193 

.serious  and  menacing  proportions,  so  much  so  that  the 
lives  of  the  officers  and  men  engaged  in  the  work  were 
threatened.  To  obviate  this  difficulty  it  was  decided  to 
put  wooden  faucets  into  the  barrels  of  drinking  water, 
.so  that  the  water  might  be  drawn  from  below,  free  from 
toil  contamination.  The  oiling  section  was  duly  supplied 
•with  these  faucets,  with  instructions  to  apply  them  to  all 
^barrels  containing  water  for  drinking  purposes.  This 
jmeasure  was  very  effective  in  allaying  irritation  and 
Avoiding  trouble  with  the  people.  .  .  .  Within  a 
short  time  the  oiling  section,  under  its  efficient  chief, 
became  so  apt  in  its  duties  that  the  entire  city  could  be 
inspected  and  oiled  in  five  or  six  days,  so  that  within 
that  time  every  water  container  and  other  deposit  of 
standing  water  was  inspected  and  treated,  making  it 
impossible  for  the  mosquito  larvae  to  arrive  at  maturity. 

Irfspite~of  all  these  efforts  the  epidemic  contin- 
ued to  increase  so  alarmingly  that  disinfection  of 
infected  houses  was  not  found  sufficient,  and  a  sys- 
tematic and  complete  disinfection  of  the  entire  city 
was  begun.  Two  sections  of  disinfecting  parties 
were  started,  therefore,  one  at  the  southeast  and 
another  at  the  northeast  extremities  of  the  town, 
working  towards  each  other.  Every  house  and 
building  was  included  in  this  disinfection:  schools, 
public  buildings,  and  churches,  no  matter  whether 
they  had  or  had  not  been  previously  disinfected. 
The  following  table,  published  by  Dr.  Guiteras, 
gives  an  estimate  of  the  work  done  from  September 
26  to  November  30 : 


194     WALTER   REED   AND   YELLOW   FEVER 

Houses  or  rooms  screened 304 

Patients  screened  under  mosquito  bars.  115 

Houses  disinfected    2,952 

Rooms  disinfected 10,045 

It  was  estimated  on  careful  calculation  that  there 
were  at  that  time  2963  houses  in  Laredo,  and  of 
these  580,  or  19.54  Per  cent-?  were  infected. 

Great  difficulty  was  experienced  in  carrying  out 
the  work  on  account,  especially,  of  the  lack  of 
authority  to  enforce  the  necessary  procedures  and 
the  ignorant  prejudice  of  the  people.  A  large  part 
of  the  inhabitants  of  Laredo  were  possessed  of  the 
idea  that  the  physicians  and  the  authorities  were  in 
a  conspiracy  to  make  money.  They  even  went  so 
far  as  to  believe  very  generally  that  the  physicians 
poisoned  their  patients  to  get  rid  of  them  and  thus 
end  the  epidemic,  and,  incredible  as  it  may  appear, 
these  opinions  were  supported  by  one  or  two 
(irresponsible)  newspapers  published  in  Laredo. 
iUnder  these  circumstances  it  is  not  surprising  that 
all  possible  means  were  used  to  secrete  cases  of 
yellow  fever  from  the  physicians  and  inspectors. 
Patients  very  ill  with  the  disease  would  hide  them- 
selves or  be  hidden  by  their  relatives,  until  at  last 
it  became  necessary  to  institute  a  house-to-house 
inspection  under  the  direction  of  the  health  officer, 
and,  later,  of  volunteer  inspectors,  appointed  by 
the  Major.  After  a  short  time  these  efforts  were 


supplemented  by  the  better  class  of  citizens,  who 
became  interested  in  the  work  and  offered  their 
services. 

Lack  of  authority  to  carry  out  sanitary  measures 
was,  however,  the  most  important  obstacle  to  suc- 
cess, and  it  may  be  said  here,  once  and  for  all,  that 
the  course  of  affairs  in  Laredo  showed  that  results 
such  as  were  obtained  in  Havana  during  the  Amer- 
ican occupation  cannot  be  achieved,  if  the  disease 
is  at  all  widespread,  unless  undisputed  authority 
is  placed  in  the  hands  of  the  sanitary  authorities 
by  Government.  The  power  exercised  in  Havana 
really  amounted  to  martial  law,  and  when  it  is 
considered  what  the  shortening  of  an  epidemic 
means  in  the  saving  of  life,  the  reducing  of  expen- 
diture, and  the  conservation  of  commercial  and 
railroad  interests,  it  becomes,  as  Dr.  Guiteras  says: 

A  serious  question  whether  under  such  circumstances 
the  establishment  of  martial  law,  or  something  equiva- 
lent to  it,  should  not  be  the  first  step  taken  in  the  sup- 
pression of  an  outbreak  of  yellow  fever,  or,  in  fact,  any 
of  the  epidemic  diseases.  ...  In  most  epidemics 
the  hardships  endured  by  the  people,  the  loss  of  life, 
the  interruption  of  commerce,  causing  heavy  financial 
losses,  all  are  greater  than  in  the  case  of  riots  or  other 
financial  disturbances  of  the  peace  for  which  ordinarily 
martial  law  is  imposed.  Such  being  the  case,  it  is  not 
clear  why  this  efficient  means  of  combating  an  epidemic 
ishould  not  be  more  strongly  recommended,  nor  why  so 


196     WALTER   REED   AND   YELLOW   FEVER 

much  opposition  should  be  aroused  against  it  when  it 
is  suggested. 

Under  martial  law  the  Laredo  epidemic  could 
have  been  controlled,  in  Dr.  Guiteras's  opinion, 
within  three  or  four  weeks  after  the  disease  had 
been  officially  declared,  on  September  25,  while, 
as  a  matter  of  fact,  the  desired  end  was  not  attained 
for  nearly  two  months,  the  quarantine  against 
Laredo  by  the  State  of  Texas  not  being  raised  until 
November  30.  Even  under  all  disadvantages,  how- 
ever, the  disease  was  completely  eradicated. 

Further  conclusive  evidence  of  the  practical 
value  of  Dr.  Reed's  discovery  has  been  given  to  the 
world  since  this  memoir  of  him  was  begun,  by  the 
records  of  the  epidemic  in  New  Orleans  in  1905. 

I  have  been  so  fortunate  as  to  obtain,  through 
the  good  offices  of  my  friend,  Dr.  Rudolph  Matas, 
a  brief  account  of  this  epidemic  from  the  pen  of 
Dr.  J.  H.  White,  Surgeon  of  the  United  States 
Public  Health  and  Marine  Hospital  Service,  who 
was  in  command  at  New  Orleans  during  the  sum- 
mer of  1905: 

NEW  ORLEANS,  LA., 

November  21,   1905. 
DR.  RUDOLPH  MATAS, 

MY  DEAR  DOCTOR  MATAS  :  In  compliance  with  your 
request,  I  submit  the  following  statement  with  regard 


MOSQUITO   THEORY   OF   YELLOW   FEVER     197 

to  the  yellow  fever  epidemic  of  1905,  and  am  sorry 
that  all  the  statements  made  cannot  be  exact,  for  the 
reason  that  the  data  have  not  as  yet  been  worked  up. 

From  information  at  hand,  it  appears  that  the  local 
Board  of  Health,  being  informed  on  the  I2th  day  of 
July  of  the  existence  of  yellow  fever  in  the  neighbour- 
hood of  the  French  Market,  undertook  to  stamp  it 
out  by  the  fumigation  of  infected  houses,  the  empty- 
ing of  water  barrels,  and  the  oiling  of  cisterns,  etc.,  in 
accordance  with  modern  ideas,  but  with  untrained  men 
and  means  entirely  inadequate  for  the  huge  task  which 
confronted  them,  it  being  probable  that  Dr.  Kohnke's 
estimate  of  100  cases  and  20  deaths  up  to  July  20, 
was  an  under-,  rather  than  an  over-,  estimate,  and  the 
number  of  concealed  foci,  therefore,  in  excess  of  what 
he  had  supposed. 

For  two  or  three  years  prior  to  this  time  Dr. 
Kohnke,  as  City  Health  Officer,  had  endeavoured  to 
inculcate  the  idea  of  mosquito  transmission,  and,  al- 
though his  efforts  were  apparently  unsuccessful,  there 
must  have  been  some  results  accomplished,  as  shown 
by  the  readiness  with  which  all  classes  of  the  people 
subscribed  to  this  doctrine  in  July  and  August,  there 
being  practically  no  exception  worthy  of  mention,  out- 
side of  the  superstitious  and  ignorant  alien  popula- 
tion. 

The  Citizens  Volunteer  Ward  Organisation,  under 
the  command  of  the  Rev.  Dr.  Beverley  Warner,  began 
on  or  about  July  24  a  general  fight  on  the  mosquito, 
which  was  of  great  value,  as  may  be  readily  seen,  it 
being  beyond  question  that  a  great  reduction  in  the 
number  of  mosquitoes  took  place  as  a  result  thereof, 


I98     WALTER    REED   AND   YELLOW   FEVER 

the  number  to  be  infected  being  necessarily  reduced  in 
like  proportion. 

It  is  difficult  to  estimate  how  many  cases  existed  on 
the  2ist  day  of  July,  when  the  presence  of  the  epidemic 
became  known  to  the  world  at  large,  my  own  estimate 
being  148  cases  and  24  deaths  as  the  minimum,  and  a 
mathematical  calculation  would  lead  back  to  about  the 
middle  of  May,  possibly  earlier,  as  the  date  of  the  first 
case. 

On  the  4th  of  August  the  citizens  requested  that  the 
work  of  eliminating  the  disease  be  turned  over  to  the 
Public  Health  and  Marine  Hospital  Service,  sending  a 
message  to  this  effect  to  the  President,  and  the  neces- 
sary orders  were  issued. 

The  funds  for  all  of  the  work,  except  the  pay  of  the 
officers,  were  furnished  by  the  citizens,  the  State,  and 
the  city;  on  August  8  the  work  was  placed  in 
charge  of  the  Public  Health  and  Marine  Hospital 
Service,  and  on  the  next  day  organisation  was  begun. 
I  wish  to  make  it  plain  that  there  was  one  central  or- 
ganisation prior  to  the  time  the  Service  took  control, 
and  that  the  division  of  the  work  and  establishment  of 
ward  organisations  was  made  by  me  because  I  believed 
the  work  too  stupendous  to  be  handled  from  one  office. 
Seventeen  sub-headquarters  were  therefore  established. 

When  the  Service  took  hold  of  the  work  there 
had  been  616  cases  and  112  deaths  by  the  record,  and 
four  days  after  this  the  maximum  daily  report  was 
made,  showing  105  cases  on  August  12.  After  this 
the  number  of  cases  per  day  declined,  until  the  date 
in  September  shortly  following  drastic  measures  taken 
to  ascertain  concealed  cases,  which  action  was  followed 
by  a  sharp  rise  in  the  number  of  cases,  which,  in  turn, 


MOSQUITO   THEORY   OF   YELLOW  FEVER     199 

was  succeeded  by  a  genuine  decline  that  continued  to 
the  end. 

As  previously  stated,  there  was  practically  no  oppo- 
sition to  the  sanitary  measures  after  the  starting  of  the 
campaign  of  education  by  the  medical  profession  and 
the  Citizens  Volunteer  Ward  Organisation,  and  it 
may  be  stated,  broadly,  that  within  one  week  there  was 
no  opposition  worthy  to  be  called  such. 

I  had  never  before  had  the  pleasure  of  seeing  a  cos- 
mopolitan population,  or  even  one  of  a  homogenous 
character,  respond  so  readily  to  rational  teaching  and 
place  so  little  obstruction  in  the  way  of  the  rational 
work  which  was  necessary  to  be  done.  The  gigantic 
natural  difficulties  in  the  way,  the  topography  of  the 
city  lending  itself  to  the  breeding  of  mosquitoes,  made 
the  co-operation  of  the  profession  and  of  the  people  at 
large  an  absolutely  essential  pre-requisite  to  success, 
which  co-operation,  I  am  glad  to  say,  was  freely  given 
and  success  attained. 

The  work  itself  was  done  from  the  ward  headquar- 
ters, seventeen  in  number,  of  which  I  have  spoken 
above,  and  was  performed  entirely  in  accordance  with 
the  findings  of  Walter  Reed,  the  first  step  in  any  case 
of  known  infection  being  to  thoroughly  screen  the 
sick  room  and  place  a  mosquito  bar  over  the  patient, 
following  this  as  soon  thereafter  as  possible  with  a 
total  destruction  of  all  mosquitoes,  both  in  the  sick 
room  and  in  the  house.  All  rooms  were  sealed  with 
paper  strips  on  the  inside,  in  order  to  prevent  the  mos- 
quitoes from  getting  into  cracks  and  thus  escaping  the 
fumigation.  In  every  reported  case,  where  opportu- 
nity was  offered,  an  effort  was  made  to  trace  its  origin; 
namely,  to  ascertain  at  what  house  the  patient  had 


200     WALTER   REED   AND   YELLOW   FEVER 

visited  during  the  six  days  preceding  his  illness,  and  in 
this  way  many  hitherto  unknown  foci  were  discovered 
and  blotted  out. 

To  give  some  idea  of  the  vastness  of  such  an  under- 
taking in  a  city  having  a  population  of  325,000,  with 
infection  scattered  from  one  end  to  the  other,  the  fol- 
lowing facts  should  be  borne  in  mind. 

The  total  area  of  this  city  occupied  by  dwellings 
and  places  of  business  is  44  square  miles,  although  the 
geographical  area  is  196  square  miles.  There  are,  ap- 
proximately, 60,000  houses  and  70,000  cisterns. 

During  this  period  of  our  work  we  used  a  sufficient 
quantity  of  a  five  to  ten  per  cent,  solution  of  salt  to  salt 
75  miles  of  gutters,  this  requiring  nearly  3,000,000 
pounds  of  rock  salt. 

We  made  300,000  house-to-house  inspections;  dis- 
infected 55,151  rooms,  burning  for  this  purpose,  in 
round  figures,  200  tons  of  sulphur  and  5000  pounds  of 
pyrethrum.  We  used  about  60,000  gallons  of  oil  in 
gutters  and  cisterns. 

There  were  employed  in  the  work  25  commissioned 
officers,  42  acting  assistant  surgeons,  and  three  pharma- 
cists, while  the  number  of  disinfectors,  screeners,  and 
ordinary  labourers  employed  from  time  to  time  was 
over  4000,  the  largest  number  at  any  one  time  being 
1276. 

The  cost  of  the  campaign  to  the  Public  Health  and 
Marine  Hospital  Service  was  about  $50,000;  and  to 
the  city,  including  the  sums  appropriated  by  the  State, 
the  city,  and  the  citizens,  $240,000,  making  a  grand 
total  of  about  $290,000. 

The  last  well-authenticated  case  of  yellow  fever  was 
reported  on  the  5th  day  of  November,  and  of  cases 


MOSQUITO   THEORY   OF  YELLOW  FEVER     201 

which  obtained  their  infection  in  the  city    there  have 
been  practically  none  since  the  ist  of  November. 

At  the  present  writing,  November  21,  there  has  been 
no  frost  nor  any  very  near  approach  thereto. 

I  wish  to  accentuate  the  fact  that,  accepting  Reed's 
findings  in  toto,  and  not  in  part,  I  did  not  quaran- 
tine against  infected  communities,  but  allowed  people 
from  such  places  to  enter  the  city  freely,  simply  watch- 
ing them  in  order  that  any  developing  case  might  be 
cared  for.  This  involved  a  little  trouble  and  expense, 
but  no  harm  was  done,  and  the  additional  expense  thus 
incurred  was  not  a  tithe  of  what  would  have  been 
necessary  in  an  effort  to  quarantine  the  city.  I  cannot 
too  strongly  express  my  views  on  this  point,  and  one 
of  the  prime  objects  I  had  in  view  from  first  to  last 
was  to  illustrate  to  the  people  of  New  Orleans  and  to 
the  world  at  large,  that  under  rational  methods  there 
is  no  more  necessity  for  quarantining  a  city  against 
yellow  fever  than  there  would  be  to  do  so  against 
typhoid  fever.  If  the  people  and  the  profession  will 
co-operate,  there  is  absolutely  no  danger  of  a  spread, 
and  I  believe  it  a  duty  incumbent  upon  the  latter  to 
preach  this  doctrine  until  it  is  universally  accepted.  It 
certainly  was  demonstrated  here  by  allowing  several 
hundred  people  to  come  into  New  Orleans  from  Pat- 
terson and  other  infected  points,  and  to  go  freely  wher- 
ever they  would  in  the  city,  no  harm  resulting  in  any 
instance.  Very  sincerely  yours, 

J.  H.  WHITE. 

rA  strong  proof  of  the  assurance  of  safety  afforded 
by  the  present  methods  of  fighting  yellow  fever 
and  of  the  confidence  arising  from  them  is  shown 


202     WALTER   REED   AND   YELLOW   FEVER 

by  the  cheerful  spirit  with  which  the  citizens  of 
New  Orleans  encountered  the  epidemic  of  1905, 
and  the  light-heartedness  which  pervaded  the 
town,  in  marked  contrast  to  the  gloom  that,  in  for- 
mer times,  always  hung  like  a  pall  over  such  scenes. 
Mr.  Rupert  Boyce,  Dean  of  the  Liverpool  School 
of  Tropical  Diseases,  who  was  sent  to  New  Orleans 
by  that  association  as  envoy  charged  to  investigate 
yellow  fever,  has  described  this  state  of  things  most 
graphically  in  the  Southern  Magazine  for  October, 
1905. 

In  one  respect  New  Orleans  has  set  an  example  to  all 
the  world  in  the  fight  against  yellow  fever.  Coming, 
as  I  did,  a  stranger,  but  a  stranger  who  has  seen  many 
campaigns  against  similar  diseases,  the  first  impression 
that  struck  me  was  the  complete  organisation  of  the 
citizens,  and  the  rational  and  reasonable  way  in  which 
the  fight  has  been  conducted  by  them.  When  I  alighted 
from  the  car  the  first  thing  that  greeted  my  eyes  was  a 
placard — of  which  tens  of  thousands  have  been  dis- 
tributed— bearing  the  words : 

WEAR  A  SMILE  ON  YOUR  FACE 

AND  A 
FLOWER  IN   YOUR   BUTTONHOLE. 

Everywhere  I  went  I  saw  these.  Tbe  force  with 
which  such  evidences  of  the  light-hearted  spirit  in  which 
the  citizens  of  New  Orleans  sallied  forth  to  win  this 
fight  strikes  one  who  has  been  a  witness  to  the  pro- 
found gloom,  distress,  and  woe  that  cloud  every  other 
epidemic  city  cannot  be  estimated. 


That  is  the  spirit  which  has  led  to  victory.  That  is 
the  light  heart  and  gay  song  which  nerves  the  warrior 
to  invincibility.  To  go  at  the  enemy  laughing,  and  to 
fight  with  a  jest,  means  always  to  overcome  with  a 
glorious  victory. 

When  I  came,  in  the  first  part  of  September,  I  found 
the  whole  country  organised.  The  municipality  was 
organised  by  wards ;  the  medical  profession  was  organ- 
ised by  flying  squadrons;  the  State  was  organised  by 
parishes.  With  a  tangible  enemy  in  view,  the  army  of 
defence  could  begin  to  fight  rationally  and  scientifically. 
Every  individual  citizen  of  every  city  and  town,  but 
especially  of  New  Orleans,  had  taken  to  himself  new 
heart  of  grace,  because  he  knew  what  he  had  to  fight. 

To  me,  coming  as  I  did  from  many  campaigns  against 
tropical  diseases  in  many  an  odd  corner  of  the  world, 
this  organisation  appealed  more  strongly  than  I  can 
say.  An  example  to  the  world  has  been  set,  an  example 
to  every  city  in  the  civilised  world  which  shall  hence- 
forth be  attacked  by  similar  diseases. 

And  the  work  of  the  Marine  Hospital  Service  struck 
the  heart  of  the  beholder  with  joy.  Cleanly,  swiftly, 
scientifically,  the  olive-green  uniforms  darted  hither  and 
thither,  into  dens  of  filth  and  obscurity,  opening  up 
every  corner  to  the  bright  light  of  science,  working 
heroically,  and  withal  so  swiftly  that  it  was  like  watch- 
ing a  huge  machine,  well  oiled  and  efficacious,  perform- 
ing a  marvellous  task  with  perfect  show  of  ease. 

I  subjoin  a  table,  furnished  me  by  Dr.  L.  O. 
Howard,  of  the  United  States  Department  of 
Agriculture,  showing  figures  comparing  the  recent 
epidemic  at  New  Orleans  with  those  of  previous 


204     WALTER   REED   AND   YELLOW   FEVER 

years.  The  table  was  drawn  up  for  epidemics  prior 
to  1905  by  Dr.  Stanford  E.  Chaille,  the  figures  for 
1905  having  been  added  by  Dr.  White  or  one  of  his 
assistants.  The  epidemics  of  1867  and  1878  are 
those  which  should  be  compared  with  those  of 
1905,  and  on  doing  so  it  will  be  seen  that  whereas 
there  were  3107  deaths  in  1867  and  4046  in  1878, 
there  were  only  452  in  1905,  although  the  epidemic 
of  the  latter  year  promised  in  the  beginning  to  be 
more  severe  than  the  others.  It  should  also  be 
noted  that  the  Public  Health  and  Marine  Hospital 
Service  did  not  begin  its  anti-mosquito  work  until 
August  12,  of  1905.  It  is,  as  Dr.  Howard  says,  an 
overwhelming  proof  of  the  efficacy  of  treatment  on 
the  mosquito  basis. 

COMPARATIVE     TABLE    OF    DEATHS      FROM     YELLOW 
FEVER    IN    NEW    ORLEANS 


MONTHS 

1847 

1848 

1853 

1854 

1855 

1858 

1867 

1878 

1905 

May  .  . 

7 

4 

31 

? 

5 

? 

3 

July.., 

74 

33 

1571 

79 

38? 

13? 

11 

76 

57 

•>.    J  
August  

965 

700 

5133 

53? 

1786 

1140 

755 

1025 

224 

September  

1100 

467 

98? 

1734 

874 

7704 

1637 

1780 

111 

198 

176 

147 

490 

97 

1137 

1077 

1065 

56 

November  

1? 

70 

78 

131 

19 

774 

103 

147 

4 

December  

10 

4 

7 

7 

15 

76 

3 

Months  unknown.  .  .  . 

445 

22 

Totals  

7804 

877 

7848 

7475 

7670 

48  54 

3107 

4046 

457, 

MOSQUITO   THEORY   OF  YELLOW  FEVER   ,205 

The  epidemics  of  1848,  1854,  and  1855  are  least 
comparable  for  1905,  because  they  immediately 
succeeded  severe  epidemics  to  which  were  due  very 
many  immunes. 

Population  of  New  Orleans  by  U.  S.  Census, 
130,565  in  1850;  168,675  m  1860;  191,418  in  1870; 
216,090  in  1880;  and  287,104  in  1900. 

Dr.  White,  it  will  be  noticed,  speaks  strongly 
against  unnecessary  quarantine  regulations,  believ- 
ing that  the  struggle  with  yellow  fever  on  Dr. 
Reed's  principles  renders  such  regulations  as  pre- 
vailed in  former  times  entirely  superfluous,  while 
the  injury  they  inflict  on  commercial  interests  can 
hardly  be  estimated.  I  think  that  before  leaving 
this  subject  some  account  of  Dr.  Reed's  own  views 
on  the  subject  of  quarantine  will  be  in  place.2 

Under  the  admirable  system  of  inspection  and  re- 
ports as  carried  out  by  the  Marine  Hospital  Service, 
the  appearance  of  yellow  fever  at  any  foreign  port  is 
promptly  reported  for  the  information  of  the  health 
authorities  of  our  several  Atlantic  ports.  We  may 
therefore,  divide  foreign  ports  within  the  so-called  epi- 
demic zone  into  (i)  infected  and  (2)  non-infected 
ports.  Heretofore  no  distinction  has  been  made  by  the 
health  officers  of  our  Southern  ports  as  regards  quaran- 
tine regulations  from  April  i  to  November  i  between 
infected  and  non-infected  places.  All  ports  within  the 

2  "  The  Prevention  of  Yellow  Fever."  Med.  Rec.,  Oct.  26, 
1901. 


206     WALTER   REED   AND   YELLOW   FEVER 

epidemic  zone  of  yellow  fever  were  considered  as  being 
infected  places,  and  hence  passengers  and  vessels  were 
subjected  to  disinfection  of  both  baggage  and  cargoes. 

With  our  present  knowledge  of  the  way  in  which 
yellow  fever  is  propagated,  we  believe  that  in  the  treat- 
ment of  passengers,  as  well  as  of  cargoes,  a  sharp  dis- 
tinction should  be  made,  first,  between  infected  and 
non-infected  ports,  and  second,  in  the  case  of  vessels 
sailing  from  infected  ports,  between  those  that  have 
received  their  cargoes  and  passengers  in  mid-stream 
and  those  that  have  loaded  at  the  wharf.  We  believe 
that  no  quarantine  restrictions  should  be  placed  upon 
either  passengers  or  cargo  from  non-infect'ed  ports. 
In  the  case  of  a  vessel  loading  in  mid-stream  at  an  in- 
fected port  by  means  of  lighters,  we  believe  that  she 
can  only  receive  infection  in  one  way,  i.  e.}  by  passen- 
gers who  have  been  exposed  to  yellow  fever  on  shore, 
and  who,  coming  on  board,  may  thereafter  be  seized 
with  the  disease.  The  possibility  of  infected  mosqui- 
toes reaching  the  vessel  either  by  flight  or  by  means  of 
lighters,  may  be  considered  as  highly  improbable. 

Vessels  loaded  under  the  foregoing  circumstances, 
/.  e.f  by  lighters  in  mid-stream,  and  arriving  at  our 
ports  without  yellow  fever  developed  en  route  should 
have  their  non-immune  passengers  quarantined  for  five 
days,  counting  the  time  consumed  by  the  voyage  as 
part  of  the  quarantine  period,  and  should  be  allowed 
to  discharge  their  cargoes  without  delay.  If  the  disease 
has  developed  en  route  among  the  crew  or  passengers, 
the  sick  should  be  promptly  removed — the  forecastle 
or  staterooms,  as  the  case  may  be,  thoroughly  disin- 
fected with  sulphur  or  formaldehyde  gas,  and  the  ves- 
sel allowed  to  proceed  to  her  wharf. 


MOSQUITO   THEORY   OF   YELLOW   FEVER     207 

On  the  other  hand,  if  the  vessel  has  received  her 
cargo  at  the  wharf  of  an  infected  port,  there  is  a  pos- 
sibility that  she  may  have  received  infection  in  one  of 
three  ways:  first,  either  by  contaminated  mosquitoes 
that  have  bitten  a  case  of  yellow  fever  in  the  immediate 
vicinity  on  shore;  second,  by  mosquitoes  that  have  be- 
come infected  from  biting  a  yellow  fever  patient  pres- 
ent on  another  vessel  loading  at  the  same,  or  an  adja- 
cent wharf;  or,  third,  by  some  individual  who  has 
acquired  an  infection  on  shore  and  afterward  taken 
passage  on  the  vessel. 

In  our  opinion,  however,  the  chances  of  infection  of 
a  vessel  from  contaminated  mosquitoes  coming  aboard 
from  a  house  or  ship  in  close  proximity  are  very  slight, 
although  such  a  possibility  must  be  admitted,  as  well 
as  the  further  possibility  that  recently  infected  mos- 
quitoes may  have  sought  refuge  on  the  vessel  during  the 
night  preceding  her  departure.  It  is  also  possible  that  a 
case  of  mild,  and  hence  undetected,  yellow  fever,  may 
occur  on  board,  and  be  the  source  for  the  infection  of 
mosquitoes  already  present  in  the  vessel. 

Under  these  circumstances,  if  a  sufficient  number  of 
days  have  not  elapsed  between  her  port  of  departure 
and  her  port  of  arrival  in  the  United  States,  i.  e.,  six- 
teen to  twenty-one  days,  to  demonstrate  the  presence 
of  the  infected  mosquitoes  by  the  occurrence  of  a  case  or 
cases  of  yellow  fever  en  route,  we  know  of  no  way  of 
absolutely  excluding  the  possibility  of  importation 
of  the  disease  by  such  a  vessel,  than  by  detention  of 
all  non-immune  passengers  for  such  number  of  days  as 
will  show  their  freedom  from  infection,  and  by  careful 
disinfection  of  crew's  and  passengers'  quarters.  If 
more  than  twenty  days  have  elapsed  during  the  voyage 


208     WALTER   REED   AND  YELLOW   FEVER 

without  the  occurrence  of  yellow  fever,  we  see  no  good 
reason  why  either  passengers  or  vessel  should  be 
detained. 

We  have  said  nothing  about  the  disinfection  of  the 
vessel's  cargo  for  the  reason  that  we  do  not  consider 
this  to  be  necessary.  The  only  possible  excuse  for  sub- 
jecting the  cargo  to  disinfection  would  be  the  fear  of 
the  presence  of  infected  mosquitoes  in  the  vessel's  hold, 
provided  she  had  loaded  at  the  wharf  of  an  infected 
port.  In  this  instance,  if  the  voyage  has  consumed  five 
or  more  days,  all  mosquitoes  contained  in  the  hold  will 
have  died;  for,  stegomyia  fasciata  lives  only  two  days 
if  deprived  of  water.  We  cannot  too  strongly  insist  that 
the  danger  of  importation  of  yellow  fever  into  the 
United  States  lies,  not  in  the  cargo  or  personal  baggage, 
but  in  the  individual  sick  with  the  disease.  With  our 
present  knowledge  of  its  propagation,  personal  baggage 
should  no  longer  be  subjected  to  disinfection,  and  with 
our  increased  ability  to  prevent  its  spread  by  measures 
easy  of  application,  instances  should  be  few  and  ex- 
ceptional when  a  vessel  coming  from  a  yellow  fever 
port  should  be  delayed  longer  than  will  be  necessary 
to  remove  her  non-immune  passengers  who  have  not 
completed  their  period  of  five  days  since  leaving  the 
port  of  departure. 

The  chief  duty  of  quarantine  officers  hereafter  will 
consist  in  the  detection  of  mild,  or  very  mild,  cases  of 
yellow  fever.  .  .  .  While  the  exclusion  of  such  cases  is 
of  the  greatest  importance,  we  doubt,  however,  whether, 
with  our  improved  knowledge  of  how  to  prevent  the 
spread  of  yellow  fever,  it  would  be  advisable  to  place 
a  greater  burden  upon  ship's  passengers  by  extending 
the  quarantine  period  to  more  than  five  days.  It  ap- 


MOSQUITO   THEORY   OF   YELLOW  FEVER     209 

pears  to  us  rather,  that,  in  view  of  the  troublesome 
delays  to  which  passengers  and  vessels  from  yellow 
fever  ports  have  been  subjected  in  the  past,  the  time 
has  now  arrived,  when  standing  upon  more  solid 
ground,  we  will  be  justified  in  seeking  in  every  way  to 
lessen  as  much  as  possible  the  restrictions  placed  by 
present  quarantine  regulations  upon  the  ship's  cargo, 
while  we  are  adding  to  those  of  the  passengers. 

Anyone  who  reads  the  little  volume  of  quaran- 
tine regulations  issued  in  1899  by  Surgeon-General 
Walter  Wyman,  of  the  Public  Health  and  Marine 
Hospital  Service,  from  which  I  have  extracted  in 
the  following  chapter,  will  realise  how  great  a 
difference  in  quarantine  has  been  made  by  our 
present  knowledge  of  yellow  fever,  in  money,  in 
time,  in  labour,  in  commercial  injury,  and  in  per- 
sonal annoyance. 


CHAPTER  IX 

THE  VALUE   OF   DR.   REED'S   WORK  TO 
THE   WORLD 

And  the  king  said,  What  honour  and  dignity  hath  been 
done  to  Mordecai  for  this?  Then  said  the  king's  servants  that 
ministered  to  him,  There  is  nothing  done  for  him/' 

— ESTHER  vi.  3. 

NO  consideration  of  Dr.  Reed's  life  and  work 
would  be  complete  which  did  not  place  in  high 
relief  the  suffering  and  sorrow  from  which  he  has 
freed  mankind.  I  make  no  apologies,  therefore,  for 
describing  as  graphically  as  possible  the  horrors 
which  occurred  during  epidemics  of  former  times, 
in  order  to  emphasise  the  fact  that,  thanks  to  the 
labours  of  Dr.  Reed  and  his  colleagues,  the  country 
need  never  be  visited  by  another. 

Between  the  years  1702  and  1878  yellow  fever 
appeared  in  the  United  States,  according  to  Keat- 
ing, one  hundred  and  twelve  times,  its  invasions 
being  most  frequent  and  most  destructive  in  the 
Southern  States,  although  they  reached  as  far  north 
as  Nantucket  Island,  Mass.,  where  259  persons 
died  of  it  in  1763,  a  death  rate,  which,  considering 

2IO 


VALUE   OF    DR.    REED'S   WORK  211 

the  small  size  of  the  island,  must  have  represented 
a  very  high  mortality. 

The  first  epidemic  concerning  which  we  have 
reliable  information  is  that  which  visited  Philadel- 
phia in  1793.  This  has  been  vividly  described  by 
Dr.  Benjamin  Rush,  and  by  Mr.  Mathew  Carey,  a 
member  of  the  citizens'  "  Committee  for  Relieving 
the  Sick  and  Distressed,"  both  writing  immediately 
after  its  cessation;  and  by  La  Roche,  writing  in 

1855. 

The  epidemic  began  in  August  with  a  few 
scattered  cases,  which  Rush  tells  us  were  so  mild 
as  not  to  excite  suspicion  of  their  real  character. 
The  first  patient  which  Dr.  Rush  attended  was  the 
child  of  his  friend,  Dr.  Hodge,  whom  he  saw  on 
the  5th  of  August,  when  he  made  a  diagnosis  of 
bilious  fever.  His  suspicions  were  aroused,  how- 
ever, by  several  similar  cases  that  followed,  and  on 
the  1 9th  of  the  month  he  was  called  to  a  Mrs.  Le 
Maigre,  of  Water  Street,  whose  symptoms  con- 
vinced him  of  the  real  character  of  the  disease  now 
rapidly  increasing  in  the  city,  and  he,  in  conjunc- 
tion with  certain  other  physicians,  made  known  the 
condition  of  things  to  the  College  of  Physicians. 
The  first  official  notice  of  the  disease  took  place  on 
August  22,  when  the  Mayor,  Matthew  Clark- 
son,  wrote  to  the  City  Commissioners,  giving  the 
most  peremptory  orders  as  to  the  cleansing  of  the 


212     WALTER   REED   AND   YELLOW   FEVER 

streets,  and  on  the  26th  of  the  month  the  College 
of  Physicians  issued,  through  the  medium  of  the 
newspapers,  a  list  of  precautions  proper  to  be  used 
against  the  spread  of  the  disease.  In  the  light  of 
our  present  knowledge  we  see  that  these  measures 
could  have  done  nothing  for  the  safety  of  the  peo- 
ple, and  we  are  not  surprised  to  learn  that  the 
disease  gained  ground  with  the  utmost  rapidity, 
so  that  by  the  end  of  August  the  city  was  in  all 
the  horrors  of  an  epidemic. 

Mathew  Carey's  account  of  the  period,  entitled 
"A  Short  Account  of  the  Malignant  Fever  Lately 
Prevalent  in  Philadelphia,"  *  is  a  valuable  history 
of  the  epidemic.  It  contains  a  list,  based  on  burial 
returns,  of  the  dead  between  the  first  of  August  and 
the  middle  of  September,  which  is  probably  the 
most  complete  on  record,  and  numbers  4041. 

The  consternation  of  the  people  of  Philadelphia 
[writes  Carey]  at  this  period  was  carried  beyond  all 
bounds.  Dismay  and  affright  were  visible  in  the  counte- 
nance of  almost  every  person.  Of  those  who  remained 
many  shut  themselves  in  their  houses  and  were  afraid 
to  walk  the  streets 

The  corpses  of  the  most  respectable  citizens,  even 
those  who  did  not  die  of  the  epidemic,  were  carried  to 
the  grave  on  the  shafts  of  a  chair  (chaise),  the  horse 
driven  by  a  negro,  unattended  by  a  friend  or  relative, 

1  Published  by  the  author,   ist  edition,  Nov.   13,   1793. 


VALUE   OF   DR.   REED'S   WORK  213 

and  without  any  sort  of  ceremony.  People  hastily 
shifted  their  course  at  the  sight  of  a  hearse  coming  to- 
wards them.  Many  never  walked  on  the  footpath,  but 
went  into  the  middle  of  the  streets,  to  avoid  being  in- 
fected in  passing  by  houses  wherein  people  had  died. 
Acquaintances  and  friends  avoided  each  other  in  the 
streets  and  only  signified  their  regard  by  a  cold  nod. 
The  old  custom  of  shaking  hands  fell  into  such  disuse 
that  many  shrunk  back  with  affright  at  even  the  offer 
of  the  hand.  A  person  with  a  crape,  or  any  appearance 
of  mourning,  was  shunned  like  a  viper.  And  many 
valued  themselves  highly  on  the  skill  and  address  with 
which  they  got  to  the  windward  of  every  person  they 
met.  Indeed,  it  is  not  probable  that  London,  at  the  last 
stage  of  the  plague,  exhibited  stronger  marks  of  terror 
than  were  to  be  seen  in  Philadelphia  from  the  24th  or 
25th  of  August  till  pretty  late  in  September. 

While  affairs  were  in  this  deplorable  state,  and  the 
people  at  the  lowest  ebb  of  despair,  we  cannot  be  as- 
tonished at  the  frightful  scenes  that  were  enacted,  which 
seemed  to  indicate  a  total  dissolution  of  the  bonds  of 
society  in  the  nearest  and  dearest  connections.  Who, 
without  horror,  can  reflect  on  a  husband  deserting  his 
wife,  united  to  him,  perhaps,  for  twenty  years,  in  the 
last  agony — a  wife  unfeelingly  abandoning  her  husband 
on  his  death-bed — parents  forsaking  their  only  children 
without  remorse — children  ungratefully  flying  from 
their  parents  and  resigning  them  to  chance,  without  an 
inquiry  after  their  health  or  safety — masters  hurrying 
off  their  faithful  servants  to  Bush-Hill,  even  on  suspicion 
of  the  disease,  and  that  at  a  time  when,  like  Tartarus, 
it  was  open  to  every  visitant,  but  never  returned  any — 


214     WALTER   REED   AND   YELLOW   FEVER 

servants  abandoning  tender  and  humane  masters,  who 
only  wanted  a  little  care  to  restore  them  to  health  and 
usefulness — who,  I  say,  can  even  now  think  of  these 
things  without  horror?  .  .  . 

A  woman,  whose  husband  and  two  children  lay  dead 
in  the  room  with  her,  was  seized  with  the  pains  of 
labour,  without  a  mid-wife,  or  any  other  person  to  assist 
her.  Her  cries  from  the  window  brought  up  one  of  the 
carters  employed  by  the  committee  for  the  relief  of  the 
sick.  With  his  assistance  she  was  delivered  of  a  child, 
which  died  in  a  few  minutes,  as  did  the  mother,  who 
was  utterly  exhausted  by  her  labour,  by  the  disorder,1 
and  by  the  dreadful  spectacle  before  her.  And  thus  lay 
in  one  room  no  less  than  five  dead  bodies,  an  entire^ 
family,  carried  off  in  an  hour  or  two. 

In  contrast  to  these  painful  scenes  it  should  be 
mentioned  that  the  city  was  never  without  many 
beautiful  exhibitions  of  charity  and  humanity.  One 
of  these,  which,  although  no  greater  than  that  of 
others,  was  perhaps  more  extensive  in  its  results, 
was  that  of  Stephen  Girard,  a  native  of  France  and 
a  wealthy  merchant  of  the  city.  He  became  so 
touched  by  the  desolate  condition  of  the  patients 
in  the  public  hospital  at  Bush-Hill  that  he  offered 
to  superintend  the  hospital  management  himself 
while  the  fever  lasted,  and  a  Pennsylvanian,  Peter 
Helm,  offered  his  services  to  the  same  end.  No 
greater  act  of  charity  could  have  been  shown, 
for  the  Bush-Hill  Hospital  was  in  a  most  de- 


VAIUE   OF   DR.   REED'S   WORK  215 

plorable  condition  described  by  Carey  in  vivid 
terms. 

A  profligate,  abandoned  set  of  nurses  and  attendants 
(hardly  any  of  good  character  could  at  that  time  be 
procured)  rioted  on  the  provisions  and  comforts  pro- 
vided for  the  sick,  who  (unless  at  the  hours  when  the 
doctors  attended)  were  left  almost  entirely  destitute  of 
every  assistance.  The  sick,  the  dying,  and  the  dead  were 
indiscriminately  mingled  together.  Not  the  smallest  ap- 
pearance of  order  or  regularity  existed.  It  was,  in  fact, 
a  great  human  slaughter  house,  where  numerous  vic- 
tims were  immolated  at  the  altar  of  riot  and  intemper- 
ance. No  wonder,  then,  that  a  general  dread  of  the 
place  prevailed  through  the  city,  and  that  a  removal  to 
it  was  considered  as  the  seal  of  death.  In  consequence 
there  were  various  instances  of  sick  persons  locking  their 
rooms  and  resisting  every  effort  to  carry  them  away.  At 
length  the  poor  were  so  much  afraid  of  being  sent  to 
Bush-Hill  that  they  would  not  acknowledge  their  illness 
until  it  was  no  longer  possible  to  conceal  it.  For  it  is 
to  be  observed  that  the  fear  of  contagion  was  so  preva- 
lent that  as  soon  as  anyone  was  taken  sick  an  alarm  was 
spread  among  the  neighbours  and  every  effort  was  used 
to  have  the  sick  person  hurried  off  to  Bush-Hill,  to 
avoid  spreading  the  disorder.  The  cases  of  poor  people 
forced  in  this  way  to  the  hospital,  though  labouring  only 
under  common  colds  and  common  fall  fevers,  are  nu- 
merous and  afflicting.  .  .  . 

But  the  case  was  soon  altered  under  the  direc- 
tion of  the  managers,  Girard  and  Helm.  They  in- 


216     WALTER   REED   AND   YELLOW   FEVER 

troduced  such  order  and  regularity  and  had  the 
patients  treated  with  so  much  care  and  tenderness 
that  they  retrieved  the  character  of  the  hospital, 
and  in  the  course  of  a  week  or  two  numbers  of  sick 
people,  who  had  not  at  home  proper  persons  to 
nurse  them,  applied  to  be  sent  to  Bush-Hill. 

Some  slight  excuse  for  the  condition  of  Bush- 
Hill  may  be  found  in  the  fact  that  soon  after  the 
epidemic  began  all  of  the  guardians  of  the  poor 
except  three,  namely,  James  Wilson,  Jacob  Tom- 
kins,  and  William  Sansom,  ceased  the  performance 
of  their  duties  and  nearly  all  of  them  moved  out  of 
the  city.  The  whole  care  of  the  poor,  therefore,  the 
providing  for  Bush-Hill,  the  sending  of  the  sick 
there,  and  the  burying  of  the  dead  had  devolved 
upon  these  three  "  faithful  among  the  faithless 
found."  Two  of  them,  James  Wilson  and  Jacob 
Tomkins,  both  excellent  and  indefatigable  young 
men,  whose  services  were  of  the  utmost  value,  fell 
victims  to  their  devotion.  The  third,  William  San- 
som, was  likewise  taken  ill  and  brought  to  the  brink 
of  the  grave,  but  fortunately  escaped  with  his  life. 

The  number  of  physicians  in  the  city  was,  of 
course,  quite  inadequate  to  afford  the  necessary 
attendance  upon  the  ill  and  dying,  although  nearly 
all  of  them  were  faithful  to  their  post  in  danger 
and  fulfilled  their  duties  with  the  utmost  courage. 
Some  idea  of  the  terrible  strain  imposed  by  the 


VALUE   OF   DR.   REED'S   WORK  217 

circumstances  upon  the  physician  himself  may  be 
gathered  from  the  graphic  account  given  by  Dr. 
Rush  of  his  own  experiences.2 

Between  the  8th  and  i5th  of  September  I  visited  and 
prescribed  for  between  a  hundred  and  a  hundred  and 
twenty  patients  a  day.  Several  of  my  pupils  visited  a 
fourth  or  fifth  of  that  number.  For  a  while  we  refused 
no  calls.  In  the  short  intervals  of  business,  which  I 
spent  at  my  meals,  my  house  was  filled  with  patients, 
chiefly  the  poor,  waiting  for  advice.  For  many  weeks  I 
seldom  ate  without  prescribing  for  numbers  as  I  sat  at 
my  table.  .  .  .  From  my  constant  exposure  to  the 
sources  of  the  disease  my  body  became  highly  impreg- 
nated with  miasmata.  My  eyes  were  yellow  and  some- 
times a  yellow  tinge  was  perceptible  in  my  face.  My 
pulse  was  preternaturally  quick  and  my  nights  were 
rendered  disagreeable,  not  only  by  sweats,  but  by  the 
want  of  my  usual  sleep,  produced  in  part  by  the  frequent 
knocking  at  my  door  and  in  part  by  anxiety  of  mind 
and  the  stimulus  of  the  miasmata  upon  my  system.  I 
went  to  bed  in  conformity  to  habit  only,  for  it  ceased 
to  afford  me  rest  or  refreshment.  When  it  was  evening 
I  wished  for  morning,  and  when  it  was  morning  the 
prospect  of  the  labours  of  the  day,  at  which  I  often 
shuddered,  caused  me  to  wish  for  the  return  of  evening. 
The  degree  of  my  anxiety  may  be  easily  conceived  when 
I  say  that  I  had  at  one  time  upwards  of  thirty  heads 
of  families  under  my  care;  among  these  were  Mr.  Josiah 

2  "  A  Narrative  of  the  State  of  the  Body  and  Mind  of  the 
Author  during  the  Prevalence  of  the  Fever."  "  Medical  Inqui- 
ries and  Observations."  3d  edition,  Philadelphia,  1809. 


2i8     WALTER   REED  AND   YELLOW   FEVER 

Coates,  the  father  of  eight,  and  Mr.  Benjamin  Scull 
and  Mr.  John  Morell,  both  fathers  of  ten  children. 
They  were  all  in  imminent  danger,  but  it  pleased  God 
to  make  me  the  instrument  of  saving  each  of  their  lives. 
.  .  Every  moment  in  the  intervals  of  my  visits  to 
the  sick  was  employed  in  prescribing  in  my  own  house 
for  the  poor,  or  in  sending  answers  to  messages  from  my 
patients.  Time  was  now  too  precious  (October)  to  be 
spent  in  counting  the  number  of  persons  who  called 
upon  me  for  advice.  From  circumstances  I  believe  it 
was  frequently  150,  and  seldom  less  than  50  a  day  for 
five  or  six  weeks.  The  evening  did  not  bring  with  it  the 
least  relaxation  from  my  labours.  I  received  letters 
every  day  from  the  country  and  from  distant  parts  of 
the  Union  containing  inquiries  into  the  mode  of  treating 
the  disease,  and  after  the  health  and  lives  of  persons 
who  had  remained  in  the  city.  The  business  of  every 
evening  was  to  answer  these  letters  and  also  to  write  to 
my  family.  To  these  constant  labours  of  body  and  mind 
were  added  distress  from  a  variety  of  causes.  Having 
found  myself  unable  to  comply  with  the  numerous  ap- 
plications that  were  made  to  me,  I  was  obliged  to  refuse 
many  every  day.  My  sister  counted  forty-seven  in  one 
forenoon  before  eleven  o'clock.  Many  of  them  left  my 
door  with  tears,  but  they  did  not  feel  more  distress  than 
I  did  from  refusing  to  follow  them.  ...  In  rid- 
ing through  the  streets  I  was  often  forced  to  resist  the 
entreaties  of  parents  imploring  a  visit  to  their  children, 
or  of  children  to  their  parents.  I  recollect,  and  even  yet 
with  pain,  that  I  tore  myself  away  at  one  time  from  five 
persons  in  Moravian  Alley  who  attempted  to  stop  me, 
by  suddenly  whipping  my  horse  and  driving  my  chair 
as  speedily  as  possible  beyond  the  reach  of  their  cries. 


VALUE   OF   DR.   REED'S   WORK  219 

But  I  had  other  afflictions  besides  the  distress  which 
arose  from  the  abortive  sympathy  which  I  have  just 
described.  On  the  nth  of  September  my  ingenuous 
pupil,  Mr.  Washington,  fell  a  victim  to  his  humanity. 
.  .  Scarce  had  I  recovered  from  the  shock  of  the 
death  of  this  amiable  youth  when  I  was  called  to  weep 
for  another  pupil,  Mr.  Alston,  who  died  in  my  neigh- 
bourhood the  next  day.  ...  At  this  time  a  third 
pupil,  Mr.  Fisher,  was  ill  in  my  house.  On  the  26th  of 
the  month  Mr.  Coxe,  my  only  assistant,  was  seized  with 
the  fever  and  went  to  his  grandfather's.  I  followed  him 
with  a  look  which  I  feared  would  be  the  last  in  my 
house.  At  two  o'clock  my  sister,  who  had  complained 
for  several  days,  yielded  to  the  disease  and  retired  to 
her  bed.  My  mother  followed  her,  much  indisposed, 
early  in  the  evening.  My  black  servant  man  had  been 
confined  with  the  fever  for  several  days,  and  had,  on 
that  day,  for  the  first  time  quitted  his  bed.  My  little 
mulatto  boy,  of  eleven  years  old,  was  the  only  person 
in  my  family  who  was  able  to  afford  me  the  least  as- 
sistance. .  .  . 

On  the  ist  of  October,  at  two  o'clock,  my  sister  died. 
I  got  into  my  carriage  within  an  hour  after  she  expired 
and  spent  the  afternoon  in  visiting  patients.  According 
as  a  sense  of  duty  or  of  grief  has  predominated  in  my 
mind  I  have  approved  of  this  act  or  not,  ever  since. 
She  had  borne  a  share  in  my  labours.  She  had  been  my 
nurse  in  sickness,  and  my  casuist  in  my  choice  of  duties. 
My  whole  heart  reposed  itself  in  her  friendship.  .  .  . 
From  this  time  I  declined  in  health  and  strength.  All 
motion  was  painful  to  me.  My  appetite  began  to  fail. 
My  night  sweats  continued.  My  short  and  imperfect 
sleep  was  disturbed  with  distressing  or  frightful  dreams. 


220     WALTER   REED   AND  YELLOW   FEVER 

The  scenes  of  them  were  derived  altogether  from  sick 
rooms    and   graveyards.     .     .     .     For   the    first   two 
weeks  after  I  visited  patients  in  the  yellow  fever  I  car- 
ried a  rag  wetted  with  vinegar  and  smelled  it  occasion- 
ally in  sick  rooms,  but  as  I  saw  and  felt  the  signs  of  the 
universal  presence  of  miasmata  in  my  system  I  laid  aside 
this  and  all  other  precautions.  I  rested  myself  on  the 
bedsides  of  my  patients,  and  I  drank  milk  or  ate  fruit 
in  their  rooms.  Besides  being  saturated  with  miasmata 
I  had  another  security  against  being  infected  in  sick 
rooms,  and  that  was,  I  went  into  scarcely  a  house  which 
was  more  infected  than  my  own.  Many  of  the  poor  peo- 
ple who  called  upon  me  for  treatment  were  bled  by 
my  pupils  in  my  shop  and  in  the  yard,  which  is  between 
it  and  the  street.  From  the  want  of  a  sufficient  number 
of  bowls  to  receive  the  blood  it  was  sometimes  suffered 
to  flow  and  putrefy  upon  the  ground.  From  this  source 
streams  of  miasmata  were  constantly  poured  into  my 
house  and  conveyed  to  my  body  by  the  air  during  every 
hour  of  the  day  and  night.     .     .     .     My  perception 
of  the  lapse  of  time  was  new  to  me.  It  was  uncommonly 
slow.  The  ordinary  business  and  pursuits  of  men  ap- 
peared to  me  in  a  light  that  was  equally  new.  The 
hearse  and  the  grave  mingled  themselves  with  every 
view  I  took  of  human  affairs.  Under  these  impressions 
I  rebollect  being  as  much  struck  with  observing  a  num- 
ber of  men  employed  in  digging  the  cellar  of  a  large 
house  as  I  should  have  been  at  any  other  time  in  seeing 
preparations  for  building  a  palace  upon  a  cake  of  ice.   I 
recollect,  further,  being  struck  with  surprise,  about  the 
first  of  October,  in  seeing  a  man  busily  employed  in  lay- 
ing in  wood  for  the  approaching  winter.  I  should  as 


VALUE   OF   DR.   REED'S   WORK  .221 

soon  have  thought  of  making  provision  for  a  dinner 
on  the  first  day  of  the  year  1800. 

After  the  loss  of  my  health  I  received  letters  from 
friends  in  the  country,  pressing  me  in  the  strongest  terms 
to  leave  the  city.  Such  a  step  had  become  impracticable. 
My  aged  mother  was  too  infirm  to  be  removed,  and  I 
could  not  leave  her.  I  was,  moreover,  part  of  a  little 
circle  of  physicians  who  had  associated  themselves  in 
support  of  the  new  remedies.  This  circle  would  have 
been  broken  up  by  my  quitting  the  city.  The  weather 
varied  the  disease,  and  in  the  weakest  state  of  the  body 
I  expected  to  be  able,  from  the  reports  of  my  pupils, 
to  assist  my  associates  in  detecting  its  changes  and  in 
accommodating  our  remedies  to  them.  Under  these  cir- 
cumstances it  pleased  God  to  enable  me  to  reply  to  one 
of  the  letters  that  urged  my  retreat  from  the  city  that 
I  had  resolved  to  stick  to  my  principles,  my  practice, 
and  my  patients  to  the  last  extremity. 

From  the  i5th  of  October  the  disease  gradually 
declined,  and  by  December  the  city  was  free  from 
the  pestilence,  so  that  the  lath  of  that  month  was 
observed  as  a  day  of  thanksgiving.  The  total  num- 
ber of  deaths,  reckoned  from  the  burial  lists,  was 
4041,  and  as  the  city  during  the  epidemic  contained 
40,144  inhabitants,  it  was  literally  decimated. 
Much  difference  existed  among  physicians  as  to 
the  manner  in  which  the  disease  originated.  To 
our  enlightened  minds  it  would  appear  to  have 
been  imported  by  some  refugees  from  San  Do- 


mingo  who  arrived  in  Philadelphia  during  the 
latter  part  of  July.  It  is  true  that  no  cases  of  yellow 
fever  were  reported  as  occurring  among  them,  but 
then  it  is  expressly  stated  that  the  first  cases  which 
came  under  notice  were  so  mild  as  to  escape  recog- 
nition, and  that  their  nature  only  became  known 
after  others  of  a  well-marked  character  developed; 
it  seems  probable,  therefore,  that  the  imported 
cases  were  of  the  same  indefinite  character  and 
their  real  nature  was  never  known.  The  transmis- 
sion of  the  disease  becomes  perfectly  intelligible 
when  we  read  the  remark,  made  casually  by  Dr. 
Rush,  that  "  Moschetoes  (the  usual  attendants  of 
a  sickly  season)  were  uncommonly  numerous." 
Some  excellent  physicians  held  by  the  theory  of 
importation,  even  though  they  do  not  seem  to  have 
focussed  their  suspicions  upon  the  San  Domingo 
refugees;  there  were  not  wanting,  however,  per- 
sons of  high  authority,  of  whom  Dr.  Rush  himself 
was  one,  who  insisted  that  the  disease  was  gener- 
ated within  the  city,  and  Dr.  Rush  was  of  opinion 
that  a  large  quantity  of  coffee  which  had  been 
allowed  to  decay  upon  one  of  the  wharves  was  the 
whole  cause  of  the  trouble.  So  convinced,  indeed, 
was  he  that  the  disease  arose  from  this  cause  that 
he  published  a  short  address  in  one  of  the  daily 
papers,  describing  the  exact  spot  where  the  coffee 
lay  and  warning  all  persons  to  avoid  the  locality. 


VALUE   OF   DR.    REED'S   WORK  223 

I  must  not  neglect  to  mention  here  one  lay  ac- 
count of  this  epidemic,  which  is  of  peculiar  inter- 
est. The  horrors  of  that  frightful  summer  appealed 
to  the  weird  imagination  of  the  first  American 
romancer,  the  precursor  of  Hawthorne,  Charles 
Brockden  Brown  (1771-1810).  The  misery  and 
death  in  the  stricken  city  furnish  a  lurid  back- 
ground for  the  happenings  of  his  sombre  story, 
"  Arthur  Mervyn."  The  result  is  a  work  of  fiction 
containing  the  most  vivid  description  we  have  of 
the  ravages  of  yellow  fever  in  earlier  times. 

During  the  next  eighty  years  the  United  States 
was  visited  by  yellow  fever  every  year,  with  one 
exception,  1861,  in  which  no  deaths  were  reported 
from  any  quarter.  During  this  period  two  great 
epidemics  occurred,  one  in  New  Orleans  in  1853, 
and  another  in  Norfolk  in  1855.  I  will  not  pause 
to  dwell  on  fhese,  but  pass  on  to  that  terrible  visita- 
tion which  is  within  the  memory  of  most  of  us,  the 
epidemic  of  1878  in  Memphis  and  its  vicinity.  The 
history  of  this  terrible  pestilence  has  been  written 
in  the  most  graphic  manner  by  Mr.  J.  M.  Keating 
in  a  volume,  now  unfortunately  out  of  print,  en- 
titled "  History  of  the  Yellow  Fever  Epidemic  of 
1878  in  Memphis,  Tenn." 

The  pestilence  in  this  instance  began  as  early 
as  May,  when  a  steamboat,  the  Sudder,  entered 
Memphis  with  a  case  of  yellow  fever  on  board. 


224     WALTER   REED   AND   YELLOW   FEVER 

The  disease  spread  slowly  at  first  and  created  little 
alarm  until  August,  but  by  the  middle  of  that 
month  the  city  was  in  a  state  of  panic  and  everyone 
who  could,  began  to  escape. 

Men,  women,  and  children  [says  Keating],  poured 
out  of  the  city  by  every  possible  avenue  of  escape.  .  .  . 
Out  by  the  country  roads  to  the  little  hamlets  and  plan- 
tations, where  many  of  them  were  welcome  guests  in 
happier  days;  out  by  every  possible  conveyance — by 
hacks,  by  carriages,  buggies,  waggons,  furniture  vans, 
and  street-drays;  away  by  bateaux,  by  anything  that 
could  float  on  the  river;  and  by  the  railroads,  the  trains 
on  which,  especially  on  the  Louisville  road,  were  so 
packed  as  to  make  the  trip  to  that  city,  or  to  Cincinnati, 
a  positive  torture  to  many  delicate  women  every  mile  of 
the  way.  The  aisles  of  the  cars  were  filled  and  the  plat- 
forms packed.  In  vain  the  railroad  officials  plead,  in 
vain  they  increased  the  accommodations.  The  stream 
of  passengers  seemed  to  be  endless  and  they  were  as 
mad  as  they  were  many.  The  ordinary  courtesies  of 
life  were  ignored,  politeness  gave  way  to  selfishness,  and 
the  desire  for  personal  safety  broke  through  all  social 
amenities.  .  .  .  To  the  cities  of  the  far  North  and 
the  far  West  they  fled,  too  many  of  them  to  die  on  the 
way  like  dogs,  neglected  and  shunned,  as  if  cursed  of 
God;  or,  to  reach  the  wished- for  goal,  only  to  die,  a 
plague  to  all  about,  carrying  dismay  to  those  who  even 
then  were  busying  themselves  for  the  relief  of  the 
stricken  cities  of  the  South.  In  less  than  ten  days,  by 
the  24th  of  August,  twenty-five  thousand  people  had 
left  the  city  and  in  two  weeks  after  five  thousand  others 


VALUE   OF  DR.   REED'S   WORK  225 

were  in  camp,  leaving  a  little  less  than  twenty  thousand 
to  face  consequences  they  could  not  escape.     .     .     . 

By  the  last  week  in  August  the  panic  was  over  in  the 
city.  All  had  fled  who  could,  and  all  were  in  camp  who 
would  go.  There  were  then,  it  was  estimated,  about 
three  thousand  cases  of  fever  ...  an  appalling 
gloom  hung  over  the  doomed  city.  At  night  it  was 
silent  as  the  grave,  by  day  it  seemed  desolate  as  the 
desert.  There  were  hours,  especially  at  night,  when 
the  solemn  oppression  of  universal  death  bore  upon 
the  human  mind,  as  if  the  day  of  judgment  was  about 
to  dawn.  Not  a  sound  was  to  be  heard;  the  silence 
was  painfully  profound.  Death  prevailed  everywhere. 
Trade  and  traffic  were  suspended.  The  energies  of  all 
who  remained  were  engaged  in  the  struggle  with  death. 
The  poor  were  reduced  to  beggary,  and  even  the  rich 
gladly  accepted  alms.  .  .  Even  the  animals  felt 
the  oppression  and  fled  from  the  city.  Rats,  cats,  or 
dogs  were  not  to  be  seen.  Death  was  everywhere  tri- 
umphant. White  women  were  seldom  to  be  met  with, 
children  never.  The  voice  of  prayer  was  lifted  up  only 
at  the  bed  of  pain  or  death,  or  in  some  home  circle 
where  anguish  was  supreme  and  death  threatened,  as 
in  a  few  cases  he  accomplished,  total  annihilation.  Tears 
for  one  loved  one  were  choked  by  the  feeling  of  un- 
certainty provoked  by  the  sad  condition  of  another.  In 
one  case  a  family  of  four  was  found  dead  in  one  room, 
the  bodies  partially  decomposed.  There  were  no  public 
evidences  of  sorrow.  The  wife  was  borne  to  the  tomb 
while  the  husband  was  unconscious  of  his  loss,  and 
whole  families  were  swept  away  in  such  quick  succes- 
sion that  not  one  had  knowledge  of  the  other's  de- 
parture. Death  dealt  kindly  by  these.  .  .  .  Neither 


226     WALTER   REED   AND   YELLOW   FEVER 

cleanliness  nor  right  living  were  a  shield  to  stay  the 
hand  of  the  destroyer.  He  invaded  the  homes  of  the 
most  chaste  and  the  den  of  the  vilest.  He  took  inno- 
cence and  infamy  at  the  same  moment  and  spread  ter- 
ror everywhere.  Where  sorrow  was  so  general  there 
could  be  no  parade  of  it.  There  were  no  funerals  and 
but  little  demand  for  funeral  services.  The  luxuries  of 
woe  were  dispensed  with.  In  most  cases  the  driver  of 
the  hearse  and  an  assistant  composed  the  funeral  party. 
Not  infrequently  many  bodies  were  left  in  the  cemetery 
unburied  for  a  night,  so  hard  pressed  were  the  man- 
agers for  labour,  and  so  numerous  were  the  demands 
upon  what  they  had.  .  .  .  The  churches  were 
closed.  The  congregations  dispersed.  The  members 
were  far  apart.  Some  were  safe,  many  were  dead. 
Only  a  few  survived,  and  these  were  manifesting  their 
faith  by  works.  The  police  were  cut  down  from  forty- 
one  to  seven.  Their  ranks  were  recruited  and  again 
were  thinned.  They  were  a  second  and  a  third  time 
filled  up,  and  yet  death  was  relentless.  He  was  jealous 
of  all  sway  but  his  own. 

I  have  so  far  dwelt  solely  upon  the  misery  and 
sorrow  directly  attendant  on  the  march  of  the 
pestilence,  but  the  worst  horrors  following  in  its 
train  arose  from  the  lawlessness  and  criminality 
which  always  come  to  light  and  run  riot  under 
such  conditions,  when  human  nature  throws  off  all 
disguise  and  stands  forth  human. 

Petty  thieving  [says  Keating]  prevailed  as  an  epi- 
demic. This  was  principally  confined  to  food  and  cloth- 


VALUE    OF   DR.    REED'S   WORK  227 

ing,  and  wood  or  coal,  or  both.  A  few  who  came  to 
nurse  died,  leaving  full  trunks  of  silverware,  bijou- 
terie, bric-a-brac,  and  clothes,  to  prove  how  indus- 
triously they  could  ply  two  trades  and  make  one  cover 
up  and  supply  the  deficiencies  of  the  other.  A  few  of 
them  also  made  themselves  notorious  for  lewdness  and 
drunkenness.  To  these  vices  many  deaths  were  due. 
They  shocked  decency  and  outraged  humanity,  they 
were  no  better  than  the  beasts  of  the  field.  Male  and 
female  they  herded  together  in  vileness.  They  made  of 
the  epidemic  a  carnival.  .  .  .  One  of  these,  a 
woman  who  would  not  or  could  not  control  her  appe- 
tite for  strong  drink,  while  stupefied  from  wine  and 
brandy  allowed  a  poor  woman  to  leave  her  bed,  naked 
as  when  born,  and  wander  out  into  the  country  one 
inclement  night,  calling  as  she  went  for  the  husband 
who  had  preceded  her  to  the  grave  by  a  few  days.  .  .  . 
In  the  house  of  an  ex-judge,  whence  a  whole  family 
had  been  borne  to  the  grave,  the  victims  of  neglect, 
four  such  nurses  died,  and  in  the  trunks  of  one,  the 
worst  of  them,  a  woman  of  seeming  refinement,  there 
was  found  the  family  plate  and  wearing  apparel  of  the 
judge's  wife,  then  absent  in  Ohio.  This  woman  and 
her  paramours  fell  victims  to  the  fever  which  they  in- 
vited by  their  debauchery  and  hastened  by  their  excesses. 
In  the  whole  range  of  human  depravity  there  are  few 
parallels  to  these  cases.  They  illustrate  the  extremes  of 
degradation;  they  sounded  the  lowest  depths  of  vice 
and  shamed  even  the  standards  of  savage  life. 

But  it  was  not  only  among  the  lowest  and  vilest 
that  the  dark  side  of  human  nature  was  brought 


228     WALTER   REED   AND   YELLOW   FEVER 

into  evidence.  The  deterioration  of  character 
which  takes  place  under  the  effect  of  terror  and  a 
temporary  suspension  of  customary  social  restraints 
became  manifest  in  the  inhumanity  exercised 
towards  inhabitants  of  yellow  fever  districts  by 
persons  of  good  standing  and  character,  whose 
business  it  was  in  many  instances  to  do  their  utmost 
for  the  protection  of  these  sufferers. 

Dr.  George  Armstrong,  a  Presbyterian  minister, 
who  wrote  a  brief  account  of  the  epidemic  in  Nor- 
folk, in  1855,  mentions  the  following  case  of  inhu- 
manity in  quarantine  regulations  which  appeared 
in  one  of  the  Norfolk  daily  papers :  "  The  follow- 
ing order,"  says  Dr.  Armstrong,  "  was  adopted  by 
the  town  authorities  of  Welden : — Ordered — That 
if  any  person  or  persons  shall  visit  the  town  of  Wel- 
den, within  fifteen  days  after  such  person  or  persons 
shall  have  been  in  such  infected  cities,  if  white,  he 
shall  be  fined  one  hundred  dollars  for  every  day 
he  or  she  may  remain  in  the  town  of  Welden.  And 
if  a  slave,  the  owner  shall  be  fined  fifty  dollars  (if 
within  the  knowledge  of  the  owner) ,  if  not,  nine- 
and-thirty  lashes  on  his  or  her  bare  back.  If  free 
coloured,  shall  be  fined  fifty  dollars,  or  shall  re- 
ceive nine-and-thirty  lashes. — That  is,  in  substance, 
if  any  poor  negro,  likely  to  have  the  fever  in  his 
blood,  shall  enter  our  town  of  Welden,  where  God 
has  laid  his  afflicting  hand,  we  will  strip  him  to  the 


VALUE   OF   DR.   REED'S   WORK  229 

skin,  lay  on  the  lash,  and  then  turn  the  fugitive  out 
into  the  swamps  to  die." 

Mathew  Carey  (1793),  after  citing  numerous 
instances  of  the  unkindness  manifested  by  the  dif- 
ferent States  and  cities  in  their  quarantine  regula- 
tions, gives  the  following  almost  incredible  instance 
of  cruelty:  "Many  travellers  from  the  city,"  he 
says,  "  exhausted  with  fatigue  and  with  hunger, 
have  been  refused  all  shelter  and  all  sustenance, 
and  have  fallen  victims  to  the  fears,  not  to  the  want 
of  charity,  of  those  to  whom  they  applied  for  relief. 
Instances  of  this  kind  have  occurred  on  almost 
every  road  leading  from  Philadelphia.  People 
under  suspicion  of  having  this  disorder  have  been 
forced  by  their  fellow-travellers  to  quit  the  stage 
and  perish  in  the  woods  without  a  possibility  of 
procuring  any  assistance.  At  Milford,  in  Dela- 
ware State,  a  waggon-load  of  goods  from  Phila- 
delphia was  actually  burned;  and  a  woman  who 
came  with  it  tarred  and  feathered." 

But  times  of  stress  and  danger,  although  they 
bring  out  everything  brutal  and  selfish  in  human 
nature,  also  afford  opportunity  and  supply  stim- 
ulus to  all  its  finer  qualities.  It  is  a  relief  to  turn 
from  such  distressing  scenes  to  the  numerous  in- 
stances of  self-sacrifice  and  devotion  which,  to  the 
credit  of  humanity,  were  plentiful  in  all  these 
crises.  We  have  already  spoken  of  several  which 


230     WALTER   REED   AND   YELLOW   FEVER 

took  place  in  the  epidemic  of  1793,  and  I  wish 
space  permitted  me  to  do  justice  to  many  others. 

In  the  pestilence  of  1878  the  whole  country 
seemed  to  be  moved  with  compassion.  "  The  cry 
for  food,"  says  Keating,  "  for  clothing,  for  money, 
for  doctors,  for  as  many  as  a  thousand  coffins,  went 
out  by  telegraph  to  the  ends  of  the  earth,  and  a 
prompt  and  generous  response  came  back.  By  tele- 
graph, by  express,  through  the  banks,  by  private 
hands,  money  was  forwarded  by  hundreds,  by 
thousands  of  dollars — New  York  City  alone  send- 
ing altogether  $43,800.  .  .  .  The  people  of 
the  North  were  especially  urgent;  it  seemed  as 
though  they  could  not  do  enough.  *  We  send,'  they 
said,  'what  we  can;  but  you,  who  know  what  you 
need,  must  ask — "  Ask  and  ye  shall  receive."  The 
Republic  in  its  remotest  confines  was  moved  as  if 
by  a  divine  impulse.  The  leading  artists  of  the 
lyric  as  well  as  of  the  dramatic  stage  were  es- 
pecially conspicuous  in  good  gifts,  in  generous 
contributions.  .  .  .  The  miner  in  the  Nevada 
hills,  the  ranchero  in  far  California,  and  the  farmer 
in  distant  Oregon  vied  in  dispensing  a  charity  equal 
to  the  growing  exigencies  of  the  time,  while  the 
people  of  the  older  States  of  the  East,  where  organ- 
isations existed  in  every  city  and  village,  were 
eagerly  engaged  in  the  good  Samaritan's  work. 
Hundreds  of  men  and  women  volunteered 


VALUE   OF   DR.    REED'S   WORK  231 

as  nurses,  who  were  destined  to  a  speedy  death. 
.  .  .  A  long  line  of  graves  in  Elmwood  Ceme- 
tery tells  the  story  of  their  fidelity  to  a  mission  that 
was  one  purely  of  mercy  and  loving  kindness." 

Instances  of  individual  self-sacrifice  were  as 
numerous  as  in  former  years  and  they  were  con- 
spicuous among  those  whose  lives  would  have  least 
suggested  it.  "  One  unfortunate  '  woman  of  the 
town,' "  says  Keating,  "  a  phrase  which  only  too 
well  tells  her  trade,  gave  up  her  house  to  be  used 
as  a  hospital,  and  herself,  until  she  fell  in  the  act, 
nursed  the  sick,  and  closed  the  eyes  and  covered  the 
faces  of  the  dead.  Others,  doomed  like  her  to  be- 
come a  curse  instead  of  a  blessing  to  humanity, 
followed  her  example.  One  such  came  from  a 
great  city  of  the  West,  disguised  as  a  widow,  and 
faithfully  and  assiduously  continued  to  do  her  duty, 
running  the  gauntlet  of  death  every  hour:  even 
when  all  like  her  were  denounced  in  her  presence 
as  irreclaimable  and  abandoned  of  God  by  an 
earnest  Christian  woman,  whom  she  nursed  to  con- 
valescence." 

A  word  must  be  said  here  of  the  good  accom- 
plished by  the  organisation  called  the  Howard 
Association,  after  the  great  philanthropist,  John 
Howard.  The  first  of  these  associations  was  es- 
tablished in  Memphis  during  a  comparatively 
mild  epidemic  of  yellow  fever  which  occurred 


232     WALTER   REED   AND   YELLOW   FEVER 

there  in  1855,  the  object  of  the  members  being,  in 
Keating's  words,  "  to  devote  themselves  to  the 
succor  of  the  sick,  the  relief  of  the  suffering,  and 
the  burial  of  the  dead."  In  subsequent  epidemics 
these  associations  have  been  established  in  different 
cities  by  self-sacrificing  men  and  women  and  have 
accomplished  more  than  can  ever  be  estimated  in 
the  relief  of  suffering.  In  Memphis,  in  1878,  eight 
members  remained  who  had  joined  the  association 
when  there  was  special  need  in  1867,  and  these  be- 
came the  nucleus  of  a  new  association  whose  de- 
voted service  will  always  remain,  as  Keating  says, 
"  a  monument  of  human  love." 

Yet  even  the  Howard  Association  became  a 
source  of  affliction  in  some  cases.  A  number  of 
tramps,  thieves,  and  the  scum  of  humanity  in  gen- 
eral invaded  Memphis,  and  after  stealing  the 
badges  of  some  of  the  Howard  nurses,  gained 
entrance  into  houses  by  representing  themselves  as 
members  of  the  association,  and  then  made  use  of 
the  occasion  to  plunder  the  helpless  inmates,  most 
of  whom  were  prostrated  from  the  disease;  they 
even  in  some  cases  committed  murder.  This  atroc- 
ity was  soon  stopped  in  Memphis  itself,  but  in  some 
of  the  smaller  towns  where  the  disease  was  raging, 
these  impostors  did  a  great  amount  of  injury. 

One  of  these  smaller  towns,  Grenada,  Missis- 
sippi, was  the  seat  of  the  disease  in  a  peculiarly 


VALUE   OF   DR.    REED'S   WORK  233 

virulent  form,  the  death-rate  being  the  largest  ever 
known  to  follow  in  the  track  of  the  disease.  A 
trained  nurse,  Mrs.  Lena  Warner,  who  was  an  eye- 
witness of  this  terrible  episode,  has  kindly  given 
me  an  account  of  her  experience,  which  I  quote  in 
her  own  words : 

My  first  great  sorrow  came  to  me  through  this  ter- 
rible scourge,  in  1878,  in  the  town  of  Grenada,  Missis- 
sippi, a  place  of  3000  inhabitants.  History  records  this 
epidemic  as  the  most  terrible  death-rate  known.  In  my 
own  family  eight  members  were  stricken,  and  myself 
and  a  child  of  nine  years  were  the  only  ones  to  recover. 
I  can  recall  very  distinctly  the  terrible  ordeal  we  had  to 
undergo,  while  many  noble  men  and  women  sacrificed 
their  lives  to  relieve  the  helplessness  of  these  un- 
fortunate people.  They  came  from  all  sections  of  the 
country,  and  as  every  occasion  of  this  kind  is  burdened 
with  human  beasts  of  prey,  robbing  and  pilfering  the 
living,  dying,  and  dead,  so  was  this  plague-stricken 
city.  Men  sent  there  who  represented  themselves  as 
nurses  from  the  Howard  Benevolent  Association  were 
among  the  worst.  My  own  father,  while  ill  with  the 
fever,  was  choked,  robbed,  and  left  alone  to  die;  I  was 
too  ill  even  to  cry  out  for  help,  but  witnessed  the  entire 
affair.  It  was  twenty  hours  before  we  were  found  in 
this  condition.  Burning  tar,  bonfires,  and  disinfectants 
of  various  kinds  were  placed  on  the  corners  of  the 
streets,  and  yet  that  peculiar  odour  from  yellow  fever 
could  be  detected  from  every  direction.  The  only  signs 
of  traffic  were  waggons  hauling  the  dead;  few  caskets 
were  seen,  but  in  their  stead  plain  boxes  and  sometimes 


234     WALTER   REED   AND   YELLOW   FEVER 

dry  goods  boxes  were  utilised;  they  were  piled  one  on 
top  of  the  other  and  fastened  with  ropes  to  the  bed  of 
the  waggons.  Negroes  were  procured  for  this  work; 
they  were  known  to  rob  the  dead  and  the  vacant  resi- 
dences. The  following  winter  several  visits  were  made 
to  the  cabins,  where  clothing,  silver,  and  other  valu- 
ables were  found.  On  one  occasion  of  this  kind  I  was 
called  by  the  town  marshal  to  identify  some  things 
supposed  to  have  been  taken  from  our  house;  while 
looking  down  on  a  crowd  of  negroes  I  called  the  mar- 
shal's attention  to  a  negro  man  wearing  my  father's 
hat.  He  proved  to  be  a  minister,  and  we  found  a  wag- 
gon-load of  various  articles  at  his  house.  The  ne- 
groes' work  as  grave-diggers  proved  to  be  very  poor, 
as  sixteen  inches  was  afterwards  found  to  be  the  depth 
of  any  grave  made  during  that  time. 

From  a  possible  recurrence  of  horrors  such  as 
these  we  are  now  insured  by  the  labours  of  Walter 
Reed  and  his  colleagues,  who  risked  their  lives  to 
ascertain  the  facts  by  which  we  are  now  protected. 
The  reports  of  the  Army  Commission  on  yellow 
fever  are  so  modest  and  self-restrained  that  they 
give  little  or  no  idea  of  the  dangers  to  which  the 
members  were  incessantly  exposed,  nor  of  the  pain- 
ful scenes  which  they  were  daily  called  upon  to  wit- 
ness. I  quote,  therefore,  again  from  Mrs.  Warner's 
letter,  for  it  is  due  to  both  the  living  and  the 
dead  that  the  full  extent  of  their  efforts  should  be 
known. 


VALUE   OF   DR.   REED'S   WORK  235 

From  the  date  of  a  lecture  I  heard  on  yellow  fever 
delivered  by  Dr.  R.  B.  Maury  and  Dr.  R.  W. 
Mitchell,  I  was  possessed  of  a  great  desire  to  come  in 
contact  with  the  disease.  When  our  Government  called 
for  volunteer  nurses  to  go  to  Cuba  I  availed  myself  of 
this  opportunity. 

In  August,  1900,  I  was  ordered  from  Matanzas  to 
Havana.  The  night  before  my  transfer  to  Havana  I 
was  entertained  at  the  quarters  of  the  officers  of  the 
2nd  Cavalry  stationed  at  Matanzas;  there  I  met 
a  Major  Cartwright,  who  informed  me  that  he  also 
had  been  ordered  to  Havana,  as  he  was  an  immune, 
having  had  the  fever  in  '98  at  Santiago.  Two  weeks 
after  my  arrival  at  the  yellow  fever  camp  the  ambu- 
lance brought  a  patient  from  General  Lee's  head- 
quarters, and  as  I  stepped  forward  to  give  directions 
in  regard  to  him  I  recognised  Major  Cartwright. 
After  some  conversation  he  stated  that  he  could  not 
possibly  have  yellow  fever,  as  he  certainly  had  a  gen- 
uine case  in  '98.  However,  on  the  sixth  day  after  his 
arrival  he  died  of  black  vomit.  Major  Peterson  also 
thought  that  he  had  had  the  fever,  but  he  was  taken 
ill  again  with  it,  and  his  wife,  hearing  of  his  illness, 
two  hours  after  his  death,  committed  suicide  by  shoot- 
ing herself  through  the  temple  in  our  quarters  at  Las 
Animas. 

The  only  nurse  with  me  who  had  yellow  fever  was 
one  that  claimed  to  be  an  immune;  she  was  sent  to 
Major  Edmund's  residence  at  Quemados  the  night 
before  his  death;  she  returned  to  the  camp  and  four 
days  after  was  taken  with  a  mild  case.  We  had  no 
mosquitoes  in  our  camp. 


236     WALTER  REED   AND  YELLOW   FEVER 

Quarantine  was  very  strict,  but  we  continued  to  have 
yellow  fever  among  the  soldiers  and  officers;  we  were 
poorly  equipped  at  Columbia  Barracks  Detention 
Camp,  and  yet  the  mortality  was  not  so  great  as  in  this 
country.  A  few  officers  and  privates  from  the  Palace 
in  Havana  were  taken  to  Las  Animas,  a  Cuban  hos- 
pital for  civilians  under  Major  Gorgas'  supervision; 
he  called  on  our  chief  surgeon  for  help  and  I  was  or- 
dered there  for  ten  days.  At  this  place  they  were  well 
equipped,  the  nurses  being  well  cared  for  as  well  as 
the  patients.  We  lost  that  week  Major  Peterson,  Cap- 
tain Page,  the  quartermaster  sergeant,  one  soldier, 
and  one  civilian  employe.  Major  Gorgas  was  very 
successful  in  the  treatment  of  the  fever,  and  upon  my 
return  to  Camp  Columbia  I  determined  to  imitate  his 
directions. 

In  September  I  nursed  Dr.  James  Carroll,  a  mem- 
ber of  Major  Reed's  staff  of  Commissioners,  and 
he  told  me  he  experimented  upon  himself  with  the 
mosquito;  while  he  had  a  severe  case  he  did  not  have 
haemorrhages,  but  even  to  the  whites  of  his  eyes  he  was 
as  yellow  as  saffron.  A  few  days  after  Dr.  Carroll's 
chill  Dr.  Jesse  Lazear  was  stricken  with  the  fever. 
He  also  was  a  member  of  the  board  and  was  brought 
on  a  litter  to  our  camp  about  eleven  A.  M.  He  knew 
what  his  illness  was  and  informed  me  that  he  had  his 
chill  about  six  P.  M. ;  he  had  not  been  in  bed  all  night, 
as  he  was  busy  writing  up  their  experiments  in  regard 
to  yellow  fever  and  the  mosquito.  His  temperature 
was  103°,  his  pulse  80;  he  lived  five  days;  the  black 
vomit  would  spurt  from  his  mouth  up  through  the  bar 
over  his  cot.  I  had  just  relieved  the  day  nurse  and  gone 
on  for  the  night;  my  efforts  to  keep  him  in  bed  failed 


VALUE   OF   DR.   REED'S   WORK  237 

and  I  called  for  help,  but  before  assistance  reached 
me  we  had  made  several  turns  around  the  room  in  his 
efforts  to  get  out.  All  night  it  took  two  men  to  hold 
him,  and  he  died  the  next  morning. 

In  December  I  met  Major  Reed,  and  it  was  at  this 
time  that  they  had  begun  in  earnest  to  erect  buildings 
for  the  special  experiments  to  prove  that  the  mosquito 
was  the  only  source  of  infection.  Major  Reed  was  an 
officer  to  whom  we  were  all  devoted;  he  liked  best  to 
be  called  "  Doctor."  I  was  always  glad  on  my  daily 
visits  to  the  laboratory  to  catch  him  there;  he  had  won 
the  friendship  and  esteem  of  the  entire  corps,  having 
the  most  genial  manners  and  was  so  considerate  and 
kind  to  everyone.  I  do  not  feel  that  I  could  speak  in 
too  high  terms  of  Major  Reed.  At  all  times  he  was  so 
willing  to  go  into  details  with  any  part  of  the  experi- 
ment I  did  not  comprehend,  and  was  patient  enough 
to  give  me  a  peep  through  the  different  microscopes 
and  give  a  full  explanation.  I  told  him  of  our  '78  epi- 
demic, and  he  informed  me  that  Surgeon-General 
Sternberg  was  in  Memphis  at  that  time.  The  experi- 
mental camp  was  called  after  Dr.  Lazear.  In  a  state- 
ment I  heard  Major  Reed  make,  he  said  that  Dr. 
Lazear's  efforts  in  this  work  had  been  of  vast  im- 
portance. Major  Reed  was  strong  in  his  friendships, 
as  Dr.  Carroll  can  readily  testify.  I  recall  an  incident 
which  gives  an  insight  into  the  kind  of  man  he  was. 
On  one  occasion  he  moved  his  mess  quarters  because  he 
heard  his  brother  officers  use  language  at  the  table 
which  was  very  ungentlemanly.  It  was  due  to  his  inde- 
fatigable efforts  that  we  owe  our  success  with  yellow 
fever  at  Camp  Lazear,  as  we  never  lost  a  case  experi- 
mented upon. 


To  give  an  idea  of  the  frightful  mortality  of  this 
disease  in  actual  numbers,  I  turn  to  the  paper 
issued  by  Reed  and  Carroll  in  1901,  on  "The 
Prevention  of  Yellow  Fever."3 

It  would  be  difficult  to  determine  with  accuracy  the 
loss  of  life  occasioned  by  the  ninety-five  invasions  of  our 
territory  by  yellow  fever  during  the  past  two  hundred 
and  eight  years.  We  have  endeavoured  to  collect  from 
the  most  available  sources  the  mortality  caused  by  the 
disease,  but  have  been  unable  to  obtain  any  reliable  data 
for  the  earlier  epidemics.  If  we  confine  ourselves  to  the 
epidemics  which  have  occurred  since  1793,  we  find 
that  there  have  not  been  less  than  100,000  deaths  from 
this  cause.  The  greatest  sufferer  has  been  the  city  of 
New  Orleans,  with  41,348  deaths,  followed  by  the  city 
of  Philadelphia  with  10,038  deaths.  The  epidemics  of 
1855,  1873,  1878,  and  1879  claimed  7759  victims  in 
the  city  of  Memphis,  Tenn.  From  1800  to  1876 
Charleston  lost  4565  of  its  citizens  by  attacks  of 
yellow  fever.  New  York  during  the  earlier  and  later 
invasions  of  this  disease  has  had  3454  deaths,  while 
the  later  epidemic  of  1855  in  Norfolk,  Va.,  caused 
over  2000  deaths.  During  our  brief  occupation  of  the 
Island  of  Cuba  (July,  i898-December,  1900),  with 
every  precaution  brought  into  exercise  to  ward  off  the 
disease,  there  have  occurred  among  the  officers  and 
men  of  our  army  1575  cases  of  yellow  fever,  with  231 
deaths.  If  we  reckon  the  average  mortality  at  20  per 
cent,  there  have  not  been  less  than  500,000  cases  of 

3  "The  Prevention  of  Yellow  Fever."  Med.  Rec.,  Oct. 
26,  1901. 


VALUE   OF   DR.    REED'S   WORK  239 

yellow  fever  in  the  United  States  during  the  period 
from   1793  to   1900. 

Yet  the  actual  loss  of  life  from  the  disease,  ap- 
nalling  as  it  is,  is  but  a  part  of  the  distress  which 
it  has  occasioned  to  the  country.  The  pecuniary 
loss,  both  direct  and  indirect,  is  a  matter  of  serious 
moment.  Estimates  of  the  exact  amount  of  money 
loss  in  epidemics  are  hard  to  arrive  at,  since 
account  must  be  taken  not  only  of  actual  expendi- 
tures in  the  relief  or  restriction  of  an  epidemic,  but 
also  of  the  commercial  loss  resulting  from  the  in- 
terruption of  intercourse  with  the  afflicted  region 
and  the  maintenance  of  the  necessary  quarantine 
regulations.  I  have,  however,  collected  an  amount 
of  information  sufficient  to  demonstrate  conclu- 
sively the  heaviness  of  the  loss,  although  it  is  some- 
what miscellaneous  in  character. 

Keating  states  that  the  amount  contributed  by 
the  world  at  large  for  the  relief  of  the  stricken  cities 
of  the  South  in  1878  was  $4,548,703.  Dr.  Horl- 
beck,  chairman  of  the  committee  appointed  in 
1897  to  investigate  the  aetiology  of  yellow  fever, 
states  in  his  report  that  the  total  loss  to  the  country 
in  the  1878  epidemic  was  not  less  than  $100,000,000. 
The  loss  to  the  city  of  New  Orleans  alone  was 
over  $10,000,000.  Evidence  given  before  a  Con- 
gressional Committee  in  1897  disclosed  the  fact 


240     WALTER   REED   AND   YELLOW   FEVER 

that  the  loss  incurred  by  the  Southern  Pacific  Rail- 
way Company  in  Texas  and  Louisiana  during  the 
epidemic  of  1897  was  in  excess  of  one  million  of 
dollars.  So  strongly  has  our  national  prosperity 
always  been  affected  through  commercial  losses 
occasioned  by  the  disease  that  the  probability  of 
their  arising  from  the  introduction  of  yellow  fever 
into  our  Southern  States  was  in  former  years  con- 
sidered a  serious  obstacle  to  the  annexation  of  Cuba. 
In  1889  Dr.  Benjamin  Lee,  then  president  of  the 
State  Board  of  Health  of  Louisiana,  read  before 
the  association  a  paper  with  the  title,  "  Do  the 
Sanitary  Interests  of  the  United  States  Demand  the 
Annexation  of  Cuba?"  in  which  this  sentence  oc- 
curs: "A  single  widespread  epidemic  of  yellow 
fever  would  cost  the  United  States  more  in  money, 
to  say  nothing  of  the  grief  and  misery  which  it 
would  entail,  than  the  purchase  of  Cuba."  In 
forcible  comparison  with  this  statement  are  the 
words  of  General  Leonard  Wood,  spoken  at  the 
memorial  service  in  honour  of  Dr.  Reed.  "  I  know 
of  no  man,"  he  said,  "  who  has  done  so  much  for 
humanity  as  Major  Reed.  His  discovery  results  in 
the  saving  of  more  lives  annually  than  were  lost 
in  the  Cuban  war  and  saves  the  commercial  in- 
terests of  the  world  a  greater  financial  loss  in  each' 
year  than  the  cost  of  the  entire  Cuban  war."  When 
we  look  back  over  our  history  in  the  immediate 


VALUE   OF   DR.   REED'S   WORK  241 

past  and  remember  that  our  occupation  of  Cuba 
was  (let  us  hope  at  least  to  some  extent)  actuated 
by  dictates  of  humanity  which  forbade  us  to  leave 
the  people  we  had  freed  unprotected  and  undevel- 
oped, we  realise  that  we  have  our  reward,  in  our 
deliverance  from  the  very  evil  which  we  were  sup- 
posed to  entail  upon  ourselves  in  thus  fulfilling  our 
duty  to  our  neighbour. 

Another  source  of  expense  to  the  country  against 
which  we  are  now  insured,  is  that  involved  in 
keeping  up  expensive  quarantine  regulations,  now 
shown  to  be,  to  a  large  extent,  unnecessary.  I  have 
no  means  of  estimating  the  direct  cost  of  these,  but 
some  idea  of  it  may  be  formed  from  a  little  volume 
on  United  States  Quarantine  Regulations,  issued 
in  1889  by  Surgeon-General  Walter  Wyman. 
After  considering  the  nature  of  yellow  fever  and 
stating  directions  for  ordering  life  in  the  man- 
ner most  likely  to  escape  it,  he  proceeds  to  con- 
sider at  length  the  following  subjects:  disinfec- 
tion of  houses;  disinfection  of  baggage;  isolation 
of  infected  cases;  detention  camps;  disinfection 
of  premises;  disinfection  of  freight;  inspection  of 
trains;  regulation  of  traffic;  disinfection  of  mail; 
inspection  of  mail;  inspection  of  vessels;  disin- 
fection of  vessels;  inspection  of  territory.  When 
the  cost  of  carrying  out  all  these  measures  in  detail 
is  considered,  it  is  plain  that  protection  against 


242     WALTER   REED   AND   YELLOW   FEVER 

yellow  fever,  according  to  the  old  ideas,  was  a 
heavy  expense  to  Government.  But  nearly  all 
of  these  procedures  were  instituted  to  meet  the 
theory  of  infection  by  fomites,  and  now  that  this 
is  disproved  all  expedients  based  upon  it  are  un- 
necessary. The  few  precautions  really  essential  are 
those  given  by  Dr.  Reed,  which  we  have  already 
quoted  (see  Chapter  VII) ,  and  we  need  only  com- 
pare these  with  the  long  list  of  measures  just  cited 
to  realise  what  a  burden  of  expense  and  annoyance 
is  removed  from  the  shoulders  of  Government. 

And  now  let  us  pause  for  a  moment  to  ascertain 
what  has  been  done  by  the  world  at  large  in  ap- 
preciation of  the  man  who  has  accomplished  so 
much  in  the  service  of  his  fellow-creatures.  Let 
us  inquire,  with  the  motto  of  this  chapter,  "  What 
honour  and  dignity  hath  been  bestowed  upon  Mor- 
decai  for  this?" 

The  members  of  Dr.  Reed's  own  profession,  as 
well  as  medical  societies  and  learned  bodies,  both 
at  home  and  abroad,  have  spared  no  exertions  to 
show  their  satisfaction  in  the  distinction  he  has 
conferred  upon  his  profession;  and  his  friends  and 
acquaintances,  both  medical  and  lay,  have  shown 
a  generous  and  loving  spirit  of  appreciation  in 
the  Memorial  Association  established  by  them  to 
secure  that  some  practical  return  should  be  made 
for  his  services  to  mankind.  But  these  demonstra- 


VALUE   OF   DR.    REED'S   WORK  243 

tions,  right  and  fitting  as  they  are,  represent  only 
a  small  part  of  what  is  due.  Acknowledgment  of 
Dr.  Reed's  services  to  humanity  should  not  be  con- 
fined to  his  colleagues  and  friends.  It  is  the  nation 
which  he  has  benefited  and  the  government  he  has 
served  from  whom  it  is  due;  not  as  a  favour,  nor 
even  as  a  recompense,  but  as  a  testimonial  of  en- 
during gratitude. 

"  Yet  popular  appreciation  of  the  value  of  the 
work  of  the  yellow  fever  commission  has  been,"  so 
says  Major  Kean,  "  singularly  slow  and  imperfect. 
While  nearly  every  educated  person  in  the  United 
States  is  familiar  with  the  name  and  work  of  a 
distinguished  Austrian  surgeon  who  has  recently 
demonstrated  in  this  country  an  operation  for  the 
cure  of  a  rather  rare  deformity  in  childhood,  only 
a  small  fraction  of  them  know  anything  of  Walter 
Reed,  the  conqueror  of  the  *  yellow  plague.' ' 

"  Precedents  are  abundant,"  Major  Kean  con- 
tinues, "  for  State  aid  to  public  benefactors  and 
their  families.  The  English  Government  a  century 
ago,  when  the  purchasing  value  of  money  was  far 
greater  than  at  present,  gave  to  Jenner,  the  dis- 
coverer of  vaccination,  grants  amounting  to  £30,- 
ooo.  He  also  received  £7383  from  a  subscription 
in  India.  Pasteur,  the  founder  of  the  science  of 
bacteriology,  besides  numerous  honours  and  deco- 
rations and  money  donations  from  other  sources, 


244     WALTER   REED  AND  YELLOW   FEVER 

received  from  the  French  Government  a  pension 
of  12,000  francs.  Lister,  the  originator  of  anti- 
septic surgery,  has,  besides  numerous  honours  and 
decorations,  been  successively  knighted  and  ele- 
vated to  the  peerage.  In  this  country  a  bill  to 
donate  $100,000  to  the  discoverer  of  anaesthesia  was 
twice  passed  by  the  Senate  (in  1853  and  1854),  but 
failed  in  the  House,  probably  only  because  of  the 
uncertainty  as  to  which  of  the  rival  claimants  was 
entitled  to  the  credit  of  the  discovery." 

It  is  Congress  towards  whom  we  naturally  look 
to  express  a  nation's  gratitude,  and  there  is  ample 
precedent,  as  we  see,  for  its  taking  action;  yet  so 
far  nothing  has  been  done  in  the  matter  beyond  the 
granting  of  a  very  modest  pension  to  Dr.  Reed's 
widow.  I  cannot  but  believe  that  such  a  state  of 
things  is  due  to  ignorance  on  the  part  of  its  mem- 
bers, not,  of  course,  of  the  work  accomplished,  but 
of  the  real  extent  of  the  evils  it  has  averted  and  of 
the  practical  benefits  it  insures  to  our  national  pros- 
perity. It  is  partly  with  the  hope  of  aiding  in  the 
dissemination  of  the  necessary  knowledge  that  this 
little  book  is  sent  forth  into  the  world,  for  I  firmly 
believe  that,  if  my  countrymen  only  understand 
the  subject  in  all  its  bearings,  they  will  find  some 
substantial  means  of  testifying  their  gratitude  to 
the  man  whose  memory  each  and  all  of  us  should 
delight  to  honour. 


CHAPTER  X 

LIFE  AFTER  RETURN  FROM  CUBA,  AND  DEATH 

1901-1902 

Scarce  had  he  need  to  cast  his  pride  or  slough  the  dross  of  earth. 
E'en  as  he  walked  that  day  to  God,  so  walked  he  from  his 

birth — 
In  simpleness  and  gentleness  and  honour  and  clean  mirth. 

— RUDYARD  KIPLING,  To  Wolcott  Balestier. 

DR.  REED  left  Cuba,  as  I  have  said,  in  February, 
1901,  and  returned  to  his  work  in  Washington.  In 
the  following  April  he  delivered  an  address  before 
the  Medical  and  Chirurgical  Faculty  of  Mary- 
land on  the  "  Propagation  of  Yellow  Fever," 
which  embodies  the  results  of  his  labours  in  a 
peculiarly  pleasing  manner.  It  was  received  by 
the  faculty  with  the  greatest  enthusiasm,  and  those 
who  were  present  will  long  remember  the  ovation 
paid  Dr.  Reed  on  this  occasion.  The  paper  was 
subsequently  published  in  the  Medical  Record  for 
August  10,  1901,  and  of  all  the  articles  written  by 
Dr.  Reed  on  the  subject,  this  will  best  repay  the 
non-professional  reader  who  may  wish  to  acquaint 
himself  with  the  subject. 

It  will  be  remembered  that  Dr.  Reed  held  one 

245 


246     WALTER   REED   AND   YELLOW   FEVER 

appointment  in  Washington  as  professor  of  bacteri- 
ology and  clinical  microscopy  in  the  Army  Medical 
School  and  another  as  professor  of  pathology  and 
bacteriology  in  the  Columbian  University.  To  his 
work  in  these  institutions  he  now  devoted  the 
greater  part  of  his  time,  and  during  the  brief  re- 
mainder of  his  life  he  was  occupied  mainly  in 
teaching,  a  line  of  work  for  which  his  natural  abil- 
ities seem  to  have  been  no  less  marked  than  they 
were  elsewhere. 

Dr.  A.  F.  A.  King  speaks  of  Dr.  Reed's  success 
as  a  teacher  thus : 

In  the  whole  domain  of  knowledge  there  is  probably 
no  subject  more  difficult  and  intricate  than  that  of  pa- 
thology, especially  when  considered  in  relation  with 
bacteriology,  this  latter  being  also  a  comparatively 
new  departure,  and  therefore  bristling  with  the  unfa- 
miliar terms  of  a  new  and  laboured  nomenclature,  as 
every  new  science  necessarily  must  be. 

Notwithstanding  these  difficulties,  Professor  Reed, 
with  his  well-trained  mind  and  cultivated  powers  of 
observation,  inspired,  too,  with  the  spirit  of  research 
and  led  on  by  the  charm  of  discovering  new  principles 
and  new  facts,  had  devoted  himself  with  so  much 
ardour,  earnestness,  and  industry  to  the  study  of  his 
chosen  sphere  of  thought  that  it  may  be  said  all  diffi- 
culties had  been  trampled  under  his  feet;  that  he  rose, 
step  by  step,  to  higher  and  still  higher  planes  of 
knowledge,  until  he  reached  an  eminence  where  the 
whole  subject  became  easily  intelligible  in  one  compre- 


LIFE   AFTER   RETURN    FROM    CUBA      247 

hensive  view  and  where  he  himself  attained  a  complete 
mastery  of  his  favourite  theme. 

Having  traversed  the  highways  of  knowledge  him- 
self, he  was  fully  able  to  lead  his  pupils  along  the  same 
paths  and  perhaps  point  out  to  them  many  short  cuts 
which  were  easier  than  the  longer  distances  and  more 
laborious  journeys  originally  pursued  by  himself.  It 
should  be  remembered  also  that  many  of  these  roads 
were  not  always  the  well-travelled  avenues  of  old  lines 
of  thought,  but,  on  the  contrary,  entirely  new,  strange, 
and  perhaps  lonely  ways,  far  out  on  the  prairies  of 
investigation,  where  briars  of  speculation,  weeds  of 
error,  and  the  ignes  fatui  of  false  theories  were  liable 
to  obstruct  and  mislead  the  honest  seeker  for  truth.  It 
was  under  these  circumstances  that  Professor  Reed  be- 
came a  trusted  guide  and  counsellor.  In  these  track- 
less wastes  of  thought  he  could  not  easily  get  lost  or 
take  a  wrong  direction,  for  in  many  instances  he  was 
able  to  say:  "I  made  these  paths  myself,"  and  he  well 
knew  whither  they  would  lead. 

A  pupil  of  his,  Captain  J.  Hamilton  Stone,  As- 
sistant Surgeon,  U.  S.  A.,  writes  of  him  as  follows : 

As  a  teacher  Dr.  Reed  always  seemed  to  me  to  be 
first  of  all,  master  of  his  theme.  His  information  was 
so  much  his  own — a  part  of  him,  as  it  were — that  when 
it  was  given  to  others  it  flowed  forth  with  unadulter- 
ated naturalness,  and  sparkled  with  a  keen  interest 
which  his  charming  personality  could  not  help  but  lend 
it.  These  qualities  would  not  permit  his  words  to  fall 
upon  deaf  ears.  His  kindly  and  considerate  mien,  to- 
gether with  his  universally  acknowledged  high  scien- 


248     WALTER  REED  AND  YELLOW  FEVER 

tific  attainments,  won  for  him  both  the  respect  and 
admiration  of  his  students.  His  language  was  always 
interesting,  eloquent,  and  well  appointed.  When  at  his 
best  his  voice  would  reach  a  high  falsetto  note,  and  this 
was  his  characteristic  method  of  impressing  important 
facts  upon  dull  or  indurate  intellects.  His  students 
never  feared  him,  but  from  the  start  regarded  him  with 
filial  affection.  Of  patience,  that  special  attribute  of  a 
good  teacher,  he  possessed  an  abundance.  He  was 
constantly  at  the  side  of  his  pupil  in  the  laboratory, 
advising,  consoling,  encouraging,  and  above  all,  in- 
structing. 

Another  student,  Mr.  H.  H.  Donnally,  says : 

Dr.  Reed's  lectures  were  models  of  order  and  sys- 
tem. A  recital  of  the  various  views  previously  held  in 
the  different  branches  of  pathology  and  bacteriology 
always  led  up  to  and  served  to  emphasise  the  more 
recent  and  generally  accepted  theories.  In  these  his- 
toric reviews  the  student  was  constantly  surprised  at 
Dr.  Reed's  remarkable  memory  for  dates  and  his  fa- 
miliarity with  the  host  of  investigators  and  their 
several  special  lines  of  research,  not  only  those  in  this 
country,  but  others  in  all  parts  of  the  civilised  world. 
This  method  of  unfolding  the  subject  historically,  with 
a  final  and  forcible  exposition  of  the  latest  current 
views,  was  keenly  appreciated  by  the  students,  and  gave 
them  a  broad  and  comprehensive  picture  of  the  whole 
subject,  which  was  easily  remembered  and  understood. 

The  summers  of  1901  and  1902,  like  many  pre- 
vious ones,  were  spent  by  Dr.  Reed  at  his  cottage 


LIFE   AFTER   RETURN   FROM   CUBA      249 

near  Monterey,  Pennsylvania,  where  out  of  a  mere 
rocky  field  he  had  made  a  pleasant  country  resi- 
dence. This  was  his  home,  which  the  many  years 
spent  by  him  as  a  wanderer  made  him  deeply  ap- 
preciate. Here  he  could  lay  aside  the  cares  and 
annoyances  of  his  work;  here  he  could  pursue 
some  of  the  various  lines  of  out-door  interest  which 
his  love  for  nature  suggested ;  and  here,  above  all, 
he  could  enjoy  the  happiness  of  unrestrained  inter- 
course with  his  family. 

"  Love  ever  at  my  fireside, 
And  peace  within  my  door" 

was  the  motto  which  he  chose  for  his  roof-tree,  and 
those  who  were  privileged  to  know  him  there, 
amidst  the  closest  intimacies  of  his  life,  realised 
to  the  full  the  peculiar  beauty  of  his  character. 
As  one  who  loved  him  says,  "  All  that  love,  self- 
sacrifice,  and  devotion  could  bring,  he  laid  upon 
the  family  altar  and  worshipped  there." 

But  those  who  saw  Dr.  Reed  during  these  last 
years  of  his  life  could  not  but  be  struck  with  the 
signs  of  fatigue  and  strain  apparent  in  his  face  and 
manner.  In  addition  to  the  cares  and  effort  inci- 
dent upon  his  work,  he  suffered,  as  all  who  achieve 
distinction  must  suffer,  from  the  injustice  and  un- 
kind judgment  of  some  of  those  to  whom  he  would 
naturally  have  looked  for  appreciation  of  his  work. 


250     WALTER   REED   AND   YELLOW   FEVER 

A  friend  who  saw  him  during  the  summer  of  1902 
says:  "  He  was  very  much  worn  by  his  scientific 
labours,  and  it  was  also  evident  that  he  felt  most 
keenly  the  attempts  which  were  being  made  by 
persons  in  authority  to  rob  him  of  his  just  fame  for 
the  work  which  he  had  done."  To  a  nature  so 
generous  and  affectionate  as  Dr.  Reed's,  the  hard- 
est part  of  such  annoyances  must  have  lain  in  the 
pain  caused  by  the  betrayal  of  those  in  whom  his 
trusting  nature  placed  entire  confidence,  and  this 
was  probably  a  harder  trial  to  him  than  the  risk 
of  losing  any  part  of  the  distinction  he  had  earned, 
for,  as  his  wife  says,  "When  his  great  work  was 
accomplished,  the  happiness  which  filled  his  soul 
was  entirely  for  the  suffering  he  would  spare  hu- 
manity. He  rejoiced  that  he  had  not  lived  in  vain, 
and  that  God  had  seen  fit  to  make  him  an  instru- 
ment of  good." 

But,  although  Dr.  Reed  had  his  share  of  mis- 
understanding to  endure,  his  work  was  not  without 
recognition  of  the  most  gratifying  description.  In 
the  summer  of  1902  Harvard  University  bestowed 
on  him  the  honorary  degree  of  M.  A.,  conferred  by 
President  Eliot  in  these  words:  "Walter  Reed, 
graduate  of  the  University  of  Virginia,  the  army 
surgeon  who  planned  and  directed  in  Cuba  the  ex- 
periments which  have  given  man  control  over  that 
fearful  scourge,  yellow  fever."  In  this  connection 


LIFE   AFTER   RETURN   FROM   CUBA      251 

I  give  a  letter  of  Dr.  Reed's  to  Dr.  Theobald 
Smith,  now  of  Harvard,  which  shows  in  a  simple, 
unaffected  manner  his  pleasure  in  the  distinction 
he  had  just  received,  and  also  gives  evidence  that 
his  interest  in  the  question  of  yellow  fever  was  as 
keen  as  it  had  ever  been. 

SURGEON-GENERAL'S  OFFICE,  WASHINGTON, 

July  18,  1902. 
MY  DEAR  DR.  SMITH  : 

On  returning  to  the  city  from  a  short  outing,  I  find 
your  kind  favour  of  the  8th  instant.  I  am,  of  course, 
extremely  interested  in  what  you  tell  me  about  the  ag- 
glutinative reactions  of  b.  icteroides  and  hog-cholera. 
Carroll  and  I,  as  you  know,  in  testing  the  blood  of  yel- 
low fever  and  hog-cholera  had  found  that  whenever  a 
given  specimen  would  clump  icteroides,  it  would  affect 
hog-cholera  in  like  manner.  With  a  culture  of  hog- 
cholera  from  Welch's  laboratory  we  got  clumping 
with  icteroides  serum  in  less  dilution  than  with  b.  icter- 
oides. We  only  tested  this  particular  serum  with  this 
one  culture  of  hog-culture.  As  to  the  significance  of 
this  clumping,  I  have  not  doubted  the  very  close  affinity 
of  these  micro-organisms  ever  since  I  found  that  b.  icter- 
oides (orig.)  when  fed  to  young  swine  would  produce 
a  fatal  infection  with  the  acute  lesions  of  hog-cholera. 

Concerning  your  inquiry  whether  there  is  viru- 
lent hog-cholera  in  Cuba,  I  think  that  I  can  safely 
answer,  Yes.  Agramonte  and  other  physicians  assured 
me  that  this  disease  was  well  known  on  the  island  and 
that,  in  certain  years,  it  caused  a  high  mortality  among 
swine.  I  did  not  see  the  disease,  as  I  made  no  attempt 


to  do  so,  but  I  think  you  can  safely  accept  its  presence 
there.  The  domestic  relations  between  the  lower  classes 
and  the  swine  are  as  intimate  as  can  be  found  among 
dwellers  in  the  same  house  and  often  in  the  same  room. 
Whether  b.  icteroides  produces  a  disease  sui  generis  in 
the  West  Indies,  I  cannot  say.  It  is  probably  responsi- 
ble for  occasional  fatal  infections  with  continued  fever. 
Thank  you  so  much  for  your  kind  congratulations 
on  the  Harvard  degree.  Of  course  I  didn't  deserve  it, 
but  I  could  not  altogether  repress  a  feeling  of  pride  in 
finding  myself  in  such  distinguished  company. 

Sincerely  yours, 

WALTER  REED. 

SKortly  after  this  the  degree  of  LL.D.  was  con- 
ferred on  him  by  the  University  of  Michigan. 

In  October,  1902,  when  Dr.  Reed  returned  to 
Washington  for  the  winter,  it  became  evident  that 
his  strength  was  much  below  par.  Each  evening 
he  came  home  worn  out  with  fatigue,  the  lines  of 
exhaustion  on  his  face  telling  plainly  that  the  day's 
work  had  been  too  much  for  his  powers.  All 
mental  exertion  became  a  painful  effort  to  him,  and 
he  complained  frequently  to  his  wife  of  the  diffi- 
culty he  experienced  in  giving  his  accustomed 
lectures.  One  night,  as  he  was  leaving  the  house 
for  the  Columbia  Lecture  Hall,  he  glanced  over 
his  notes,  and  shaking  his  head,  remarked,  "  I  can- 
not realise  that  I  ever  delivered  this  lecture.  It  is 
utterly  beyond  my  mental  capacity  now."  Before 


LIFE  AFTER   RETURN   FROM   CUBA      253 

his  friends  and  acquaintances  he  exerted  himself 
to  keep  up  his  usual  flow  of  spirits,  but  his  wife,  to 
whom  he  could  express  himself  without  restraint, 
was  so  shocked  at  the  change  wrought  in  him  by  a 
few  short  weeks  that  she  became  oppressed  by  the 
sense  of  an  impending  calamity.  The  faithful  old 
messenger  at  the  Museum  was  the  only  person 
besides  his  wife  to  whom  he  allowed  himself  to  give 
way,  and  to  him  he  said  one  day,  "  Beechner,  I  am 
a  very  sick  man." 

On  Wednesday,  the  12th  of  November,  Dr. 
Reed  returned  from  his  office  earlier  than  usual, 
and  remarked  to  his  wife  that  he  must  have  eaten 
something  at  luncheon  which  had  disagreed  with 
him.  He  was  so  ill  throughout  the  remainder  of 
the  day  that  he  could  not  go  to  his  lecture  in  the 
evening,  and  the  next  day  he  remained  in  bed  most 
of  the  forenoon.  Later  he  rose,  dressed,  and  went 
out,  although  still  complaining  of  abdominal  pain 
which  caused  him  to  limp.  On  Friday,  the  I4th, 
he  consulted  his  old  friend  and  brother  officer, 
Major  W.  C.  Borden,  stating  that  he  himself 
thought  the  trouble  was  appendicitis. 

On  examination,  Major  Borden  found  a  tender 
spot,  one-third  of  the  way  inward  from  the  right 
anterior  superior  spine,  with  increased  muscular 
tension  in  the  neighbourhood.  The  temperature 
was  then  99.4°  and  the  pulse  77.  Dr.  Borden  made 


254     WALTER   REED   AND   YELLOW   FEVER 

a  diagnosis  of  appendicitis,  but  as  Dr.  Reed  was 
much  better  next  morning,  it  was  hoped  the  worst 
was  over.  That  night  the  temperature  was  99.8° 
and  the  next  morning  it  was  98°.  Dr.  Reed  sat  up 
in  bed  most  of  that  day  (Sunday,  the  i6th) ,  begged 
for  solid  food,  read  his  letters,  talked  of  the  im- 
provements to  be  made  at  his  country  home  in  the 
spring,  saw  some  of  his  old  friends,  and  was  alto- 
gether so  well  and  bright  that  he  seemed  on  the 
high  road  to  recovery.  On  Sunday  evening,  how- 
ever, his  temperature  rose  to  100.4°,  with  some 
return  of  pain,  and  although  the  other  symptoms 
were  not  worse,  Dr.  Borden  advised  operation  as 
soon  as  possible  the  following  day.  Early  the  next 
morning,  accordingly,  Dr.  Reed  was  taken  to  the 
Army  Hospital  Barracks,  where  Dr.  Borden 
operated  at  eleven  A.  M.  Just  before  the  operation 
Dr.  Reed  said  to  his  old  friend,  Major  Kean,  to 
whom  he  was  much  attached,  "  Kean,  I  am  not 
afraid  of  the  knife,  but  if  anything  should  happen 
to  me,  I  am  leaving  my  wife  and  daughter  so  lit- 
tle;" and  as  he  went  under  the  influence  of  the 
ether  he  was  heard  to  whisper,  "  So  little,  so  little." 
Some  difficulty  was  encountered  in  finding  the 
appendix,  so  that  it  was  necessary  to  enlarge  the 
incision,  and  when  located,  it  proved  to  be  very 
large  and  closely  adherent  to  the  caput  coli.  The 
organ  was  partly  filled  with  pus  and  had  perfo- 


LIFE   AFTER   RETURN   FROM   CUBA      255 

rated  at  one  point,  but  the  pus  had  not  escaped  into 
the  abdominal  cavity  on  account  of  a  thin  wall  of 
adhesions.  During  the  separation  of  these  adhe- 
sions pus  escaped,  but  as  it  was  carefully  taken  up 
with  a  dry  sponge,  Dr.  Borden  believed  that  none 
escaped  into  the  abdomen.  As  the  appendix  was  so 
necrotic  at  the  base  that  no  invagination  of  the 
stump  was  possible,  it  was  simply  ligated.  Gauze 
drainage  was  inserted,  the  lower  end  of  the  drain 
being  carefully  packed  over  the  stump  down  into 
the  space  between  the  posterior  abdominal  wall 
and  lower  end  of  the  caecum  where  the  pus  had 
gravitated.  The  appendix,  itself,  on  examination 
showed  evidence  of  considerable  previous  inflam- 
mation, and  it  became  plain  that  certain  attacks  of 
"  indigestion  "  and  "  intestinal  colic,"  from  which 
Dr.  Reed  had  suffered  occasionally  for  some  years, 
had  been,  in  reality,  mild  attacks  of  appendicitis. 

The  overwork  and  anxiety  which  Dr.  Reed  had 
borne  so  cheerfully  during  previous  years  had  their 
effect  now.  He  reacted  badly  from  the  operation, 
the  nausea  continuing  for  nearly  eighteen  hours, 
and  even  after  this  was  relieved  he  suffered  from 
almost  uncontrollable  nervousness  and  great  de- 
pression. 

His  friend,  Major  Kean,  who  saw  him  every  day 
during  his  illness,  found  him  still  anxious  to  a 
painful  degree  as  to  the  future  of  his  family.  His 


256     WALTER   REED  AND  YELLOW   FEVER 

son,  Walter  Lawrence  Reed,  a  young  man  of 
twenty-four,  had  entered  the  United  States  Army 
as  a  profession,  and  was  then  beginning  a  success- 
ful career,  but  the  provision  for  Mrs.  Reed  and 
her  daughter  in  case  of  Dr.  Reed's  death  was  sadly 
inadequate.  While  trying  to  cheer  him,  Major 
Kean  told  him  that  he  knew,  in  confidence,  that 
the  Secretary  of  War  had  recommended  his  promo- 
tion to  the  rank  of  colonel  in  his  annual  report. 
Major  Reed  frowned,  and  then  answered,  "  I  care 
nothing  for  that  now."  It  was,  as  Major  Kean 
says,  the  reply  of  Lancelot  of  the  Lake,  "  Prize  me 
no  prizes,  for  my  prize  is  death." 

Dr.  Borden  had  predicted  at  the  operation  that 
sloughing  and  a  faecal  fistula  would  almost  in- 
evitably ensue,  on  account  of  the  rigid  and  dis- 
coloured condition  of  the  caecum,  and  when  the  first 
packing  was  removed  on  the  fourth  day  this  pre- 
diction was  found  to  be  fulfilled.  On  the  fifth  day 
symptoms  of  peritonitis  appeared,  indicating  a 
rupture  into  the  general  peritoneal  cavity,  and 
from  this  time  Dr.  Reed  sank  rapidly  and  died 
peacefully  in  a  state  of  unconsciousness  on  the  sixth 
day  after  the  operation,  November  22,  1902. 

His  funeral  took  place  with  military  honours  on 
Tuesday  morning,  November  25,  from  St.  Thomas' 
Church,  Washington.  The  pall-bearers,  all  officers 
of  the  Medical  Corps  of  the  Army,  were :  General 


LIFE  AFTER   RETURN   FROM   CUBA      257 

Calvin  DeWitt,  Majors  Louis  A.  La  Grade,  W.  B. 
Davis,  W.  D.  McCaw,  J.  R.  Kean,  and  W.  B. 
Banister.  A  large  number  of  persons  were  present 
in  spite  of  most  inclement  weather,  among  them 
the  students,  officers,  and  professors  of  the  Army 
Medical  School  and  Navy  Medical  School,  in 
uniform;  a  number  of  general  officers  and  their 
staffs;  the  professors  and  many  students  from  the 
Columbian  University,  besides  a  large  concourse 
of  friends  and  many  distinguished  scientific  men, 
among  them  Dr.  Reed's  beloved  teacher  and  friend, 
Professor  William  H.  Welch. 

Dr.  Reed's  remains  are  interred  at  Arlington, 
on  a  beautiful  knoll,  overlooking  the  city  of  Wash- 
ington, and  here  Mrs.  Reed  has  erected  a  simple 
but  striking  monument  to  his  memory.  It  is  a  shaft, 
five  feet  high,  of  dark  Quincy  granite,  with  an 
oblong  bronze  tablet,  bearing  this  inscription,  se- 
lected by  the  Surgeon-General  and  his  staff: 

Walter  Reed,  M.  D.  of  the  University  of  Virginia. 

A.  M.  of  Harvard  University, 

LL.D.  of  the  University  of  Michigan, 

Professor  of  Bacteriology,  Army  Medical  School 

and 

Columbian  University,  Washington,  D.  C. 

"  He  gave  to  man  control  over  that  dreadful  scourge, 

Yellow  Fever." 


258     WALTER   REED   AND   YELLOW   FEVER 

The  quotation  is  taken  from  President  Eliot's 
address  when  he  conferred  upon  Dr.  Reed  the 
Harvard  honorary  degree,  a  distinction  in  which 
Dr.  Reed  took  such  especial  pleasure  that  it  seems 
peculiarly  fitting  it  should  mark  his  last  resting 
place.  A  very  successful  marble  bust  of  Dr.  Reed, 
by  the  young  sculptor,  Hans  Schuler,  has  recently 
been  placed  in  the  Surgeon-General's  Library  in 
Washington. 

The  news  of  Dr.  Reed's  untimely  death  was  re- 
ceived by  his  profession  and  by  the  scientific  world 
at  large  with  poignant  regret.  The  loss  of  such  a 
man,  at  the  zenith  of  his  usefulness,  with  powers 
undimmed,  and  a  future  full  of  possibilities,  was 
a  bereavement  which  reached  far  beyond  his  own 
immediate  circle  and  occasioned  a  national  regret. 
Expressions  of  grief,  and  of  sympathy  for  his 
family,  came  freely  from  every  side,  couched  in 
terms  of  the  most  genuine  feeling. 

The  New  York  Academy  of  Medicine,  the 
University  of  Virginia,  Columbia  University,  the 
American  Academy  of  Medicine,  the  International 
Congress  of  Medicine,  and  many  other  scientific 
bodies  at  home  and  abroad  passed  resolutions  ex- 
pressing their  sense  of  the  loss  sustained  by  the 
profession  and  their  sympathy  for  Dr.  Reed's 
family.  The  Medical  Society  of  the  District  of 
Columbia,  of  which  Dr.  Reed  had  been  a  distin- 


MAJOR    WALTER    REED 

Bust  by  Hans  Schuler.      Now  in  the  library  of  the  Surgeon-General 
in  Washington 


LIFE   AFTER   RETURN    FROM   CUBA       259 

guished  member,  held  a  memorial  service  on  De- 
cember 31,  1902,  at  which  some  of  his  friends  and 
brother  officers  spoke  on  different  aspects  of  his 
life  and  work.  I  have  already  quoted  largely  from 
the  addresses  made  on  this  occasion,  and  I  will 
pause  here  only  to  emphasise  one  point  which 
strikes  the  reader  forcibly  in  all  of  them,  namely, 
the  note  of  personal  feeling  apparent  under  the 
most  conventional  forms  of  expression.  It  would 
seem  as  though  no  one  could  come  in  contact  with 
Dr.  Reed  without  experiencing  the  charm  and 
force  of  his  personality  in  a  lasting  manner,  so  that 
even  those  whose  knowledge  of  him  was  limited 
to  a  passing  acquaintance  experienced  a  sense  of 
individual  loss  on  hearing  he  was  gone. 

All  of  the  leading  medical  journals  published 
expressions  of  appreciation  of  Dr.  Reed's  work 
and  grief  for  his  untimely  end.  One  of  these,  in 
particular,  by  Dr.  George  Nuttall  in  the  Journal 
of  Hygiene  for  April,  1903,  contains  an  interesting 
account  of  his  work  and  a  warm-hearted  defence 
of  his  claims  to  distinction  against  his  detractors. 

During  the  winter  following  Dr.  Reed's  death 
a  strong  desire  arose  among  his  friends  as  to  the 
establishment  of  some  memorial  in  his  honour. 
The  project  first  assumed  definite  shape  at  a  dinner 
given  by  Professor-  Alexander  Graham  Bell  to  a 
number  of  the  members  of  the  Association  of 


260     WALTER   REED   AND  YELLOW   FEVER 

American  Scientists,  and  early  in  1903  a  certificate 
of  incorporation  was  filed  in  Washington  for  the 
Walter  Reed  Memorial  Association,  in  order  that 
further  steps  might  be  taken  on  an  organised  basis. 
The  officers  of  the  Association  are:  Dr.  D.  C.  Gil- 
man,  president;  General  G.  M.  Sternberg,  vice- 
president;  Mr.  Charles  J.  Bell,  treasurer;  General 
Calvin  De  Witt,  secretary;  with  an  executive 
committee  consisting  of  Major  J.  R.  Kean,  Major 
W.  D.  McCaw,  and  Dr.  A.  F.  A.  King.  The 
American  Medical  Association  appointed  a  com- 
mittee to  co-operate  with  the  Memorial  Associ- 
ation, of  which  Dr.  W.  W.  Kean  of  Philadelphia 
is  chairman,  and  the  Association  for  the  Advance- 
ment of  Science  did  the  same,  with  Dr.  D.  C.  Gil- 
man  as  its  head. 

On  August  15,  1903,  the  various  committees  met 
at  Bar  Harbor,  Maine,  in  order  to  confer  as  to 
the  steps  proper  to  be  taken  and  to  determine  the 
nature  of  the  memorial.  Representative  men  from 
all  parts  of  the  country  were  present,  and  letters 
were  received  from  various  minor  committees.  It 
was  then  determined  to  make  every  effort  to  raise 
by  subscription  a  fund  of  twenty-five  thousand  dol- 
lars, the  income  of  which  should  be  devoted  to 
Dr.  Reed's  widow  and  daughter  during  their  lives, 
while  at  their  decease  the  principal  should  be  used 
either  in  the  erection  of  a  monument  to  Dr.  Reed's 


LIFE   AFTER   RETURN   FROM   CUBA      261 

memory  or  in  the  promotion  of  researches  in  his 
especial  field  of  work. 

Circulars  were  then  issued  inviting  subscriptions 
to  the  Walter  Reed  Memorial  Fund,  payable  to 
the  treasurer,  Mr.  Charles  Bell,  American  Secur- 
ity Trust  Co.,  Washington,  D.  C.,  or  to  any  mem- 
ber of  the  special  committees.  In  January,  1905,  a 
second  circular  was  issued,  stating  the  amount  col- 
lected up  to  that  time,  which  was  thirteen  thousand 
dollars,  and  extending  the  subscription,  which  had 
hitherto  been  restricted  to  members  of  the  medical 
profession,  to  other  subscribers,  in  the  following 
terms :  "  An  appeal  is  now  made  to  a  wider  circle 
of  those  who  appreciate  the  magnitude  of  Dr. 
Reed's  services  and  the  benefit  he  has  conferred 
upon  the  sanitary  conditions  of  southern  seaports, 
upon  the  commerce  and  prosperity  of  the  country 
at  large,  and  upon  the  welfare  of  mankind." 

The  response  to  this  circular  has  been  most 
generous.  I  learn  from  the  treasurer  of  the  Asso- 
ciation, Mr.  Charles  Bell,  that  at  the  time  I  write, 
October,  1906,  the  sum  in  hand  is  a  little  over 
twenty-four  thousand  dollars,  and  it  is  hoped  the 
small  amount  still  lacking  will  be  completed  this 
year. 


CHAPTER   XI 

THE  OTHER  MEMBERS  OF  THE  YELLOW 
FEVER   COMMISSION 

And  there  some  v.-hom  a  thirst 
Ardent,  unquenchable,  fires, 
Not  with  the  crowd  to  be  spent, 
Not  without  aim  to  go  round 
In  an  eddy  of  purposeless  dust. 
Effort  unmeaning  and  vain. 

— MATTHEW  ARNOLD,  Rugby  Chapel. 

IT  would  not  be  fitting  that  this  volume  should 
close  without  special  mention  of  the  men  associated 
with  Dr.  Reed  in  his  experimental  work.  It  is 
true  that  "  his  was  the  master  mind  and  he  the 
guiding  spirit,"  but  his  three  associates  gave  them- 
selves to  the  cause  with  no  less  devotion  than  he; 
two  of  them  suffered  from  the  disease,  and  one  lost 
his  life  by  it.  If  the  pestilence  at  our  gates  has  been 
stayed  by  the  efforts  of  the  Commission,  ought  we 
not  to  honour  these  "  brave  soldiers  in  the  Libera- 
tion War  of  Humanity,"  by  whom  the  victory  has 
been  gained,  only  less  than  their  commander? 

JAMES    CARROLL 

Dr.  James  Carroll  was  born  at  Woolwich,  Eng- 
land, on  June  5,  1854.  ^e  received  a  good  com- 

263 


YELLOW   FEVER  COMMISSION  263 

mon  school  education,  and  when  he  was  fifteen 
emigrated  to  Canada,  where  for  some  years  he 
lived  the  life  of  a  backwoodsman.  In  1874  ^e 
entered  the  United  States  Army  and  afterwards, 
while  still  a  soldier,  he  began  the  study  of  medi- 
cine at  the  University  of  the  City  of  New  York, 
during  the  session  of  1886-1887.  After  the  break 
of  a  year  he  resumed  his  medical  studies  in  Balti- 
more, at  the  University  of  Maryland,  in  1889-1891, 
and  received  his  degree  from  that  institution.  Dur- 
ing the  winters  of  1891-1892  and  1892-1893  he 
undertook  some  post-graduate  work  at  the  Johns 
Hopkins  Hospital  in  pathology  and  bacteriology. 
His  first  association  with  Dr.  Reed  was  in  1893, 
when  he  was  assigned  to  duty  at  the  Army  Medical 
School  in  Washington,  and  they  continued  to  be 
more  or  less  connected  during  the  next  six  years. 
In  1899,  as  I  have  related  elsewhere,  they  were 
both  appointed  by  Surgeon-General  Sternberg  to 
investigate  the  true  nature  of  the  bacillus  icter- 
oides,  which  Sanarelli  asserted  was  the  specific 
cause  of  yellow  fever,  and  in  1890,  when  the  Army 
Commission  on  yellow  fever  was  appointed,  Dr. 
Carroll  was  placed  second  in  command.  He  sailed 
from  New  York  in  company  with  Dr.  Reed  on 
June  21,  1900,  and  reached  Havana  on  the  25th. 
On  August  4,  when  matters  were  in  working  train 
in  Cuba,  Dr.  Reed  returned  to  the  United  States 


264    WALTER   REED   AND  YELLOW   FEVER 

for  two  months  on  official  business,  and  Dr.  Carroll 
remained  at  the  head  of  affairs  in  Cuba.  It  was 
during  this  interval  that  he  had  the  attack  of  yel- 
low fever,  described  as  the  first  case  produced 
experimentally  by  the  bite  of  the  mosquito.  Dr. 
Carroll  himself  says  that  the  proudest  circum- 
stance of  his  life  is  the  fact  that  he  was  the  first 
person  to  succumb  to  mosquito  inoculation,  al- 
though, he  adds,  "  with  a  wife  and  five  young 
children  at  home,  my  thoughts  during  the  serious 
part  of  my  illness  may  be  better  imagined  than 
described." 

During  Dr.  Carroll's  convalescence  an  incident 
occurred  which  caused  him  a  good  deal  of  amuse- 
ment. One  of  his  nurses,  who  came  from  Tennes- 
see, had  had  considerable  experience  with  yellow 
fever,  having,  indeed,  lost  her  husband  and  sev- 
eral children  from  it.  One  day  early  in  his  ill- 
ness, Dr.  Carroll  mentioned  to  her  that  he  had 
contracted  the  disease  through  the  bite  of  a  mos- 
quito and  noticed  that  she  looked  surprised.  Some 
time  later,  when  well  enough  to  look  over  the  daily 
records  of  his  condition,  he  found  this  entry: 
"  Says  he  got  his  illness  through  the  bite  of  a 
mosquito — delirious!  " 

Although  Dr.  Carroll  made  a  rapid  recovery 
from  yellow  fever,  he  did  not  entirely  escape  its 
effects.  During  the  course  of  the  illness  he  had  a 


YELLOW   FEVER  COMMISSION  265 

sudden  heart  attack,  the  nature  of  which  is  best 
described  in  his  own  words:  "  From  personal  ex- 
perience I  think  more  stress  should  be  laid  on  the 
necessity  for  confining  mustard  foot-baths  to  the 
earliest  stage,  as  laid  down  by  Sternberg  and 
nearly  all  writers.  In  my  own  case  it  was  used  for 
the  first  time  on  the  third  day,  and  I  shall  never 
forget  the  effect  of  it.  Within  half  an  hour  after 
the  removal  of  the  foot-bath,  and  while  I  was 
oppressed  with  a  weight  of  heavy  grey  blankets, 
I  felt  a  sudden  pain  and  embarrassment  at  the 
heart.  The  pain  was  very  acute  and  accompanied 
with  a  feeling  of  distention,  as  if  the  organ  was 
much  distended  and  was  being  arrested  in  diastole. 
Happily,  it  lasted  but  a  few  moments.  This  was 
the  only  time  I  felt  myself  to  be  in  imminent 
danger."  l  Unfortunately,  the  effects  of  this  attack 
were  not  so  transitory  as  Dr.  Carroll  believed 
when  he  first  wrote  his  account  of  it.  Subsequent 
events  have  shown  that  this  was,  undoubtedly,  an 
acute  dilatation  of  the  heart,  which  has  induced 
a  permanent  valvular  lesion  that  limits  Dr.  Car- 
roll's activity  and  has  caused  his  rejection  by  a  life 
insurance  company. 

Early  in  October,  1900,  Dr.  Reed  returned  to 
Cuba  to  collect  material  for  the  preliminary  re- 

1  "  The  Treatment  of  Yellow  Fever,"  Jour.  Amer.  Med. 
Assoc.,  July  19,  1902. 


266    WALTER   REED  AND   YELLOW   FEVER 

port  of  the  Commission.  This  occupied  about  ten 
days,  after  which  he  again  went  back  to  the  United 
States,  where  he  presented  the  first  results  of  the 
work  before  the  American  Public  Health  Asso- 
ciation in  Indianapolis,  at  the  end  of  October. 
Shortly  after  the  ist  of  November  Dr.  Reed  was 
once  more  in  Cuba,  and  resumed  the  personal 
supervision  of  the  work. 

All  the  reports  of  the  Commission  bear  Dr. 
Carroll's  name  as  well  as  that  of  Dr.  Reed,  and 
in  reading  them  we  should  always  bear  in  mind 
that,  while  the  experiments  were  planned  by  the 
master  mind  of  the  chief,  the  accuracy  with  which 
they  were  carried  out  and  the  care  by  which  all 
possible  precautions  were  taken  to  exclude  every 
source  of  error,  are  due  to  Dr.  Carroll  quite  as 
much  as  to  Dr.  Reed. 

In  February,  1901,  when  the  work  at  Camp 
Lazear  was  finished,  Dr.  Reed  returned  to  the 
United  States,  but  Dr.  Carroll  remained  for  some 
weeks  longer  in  order  to  investigate  into  the  con- 
dition of  the  urine  in  yellow  fever,  as  well  as  to 
ascertain  how  long  the  mosquito  is  capable  of 
conveying  the  infection.  He  sailed  for  home  on 
March  4,  but  the  following  August  he  returned 
to  Cuba  alone,  having  been  sent  by  the  United 
States  Government  for  the  purpose  of  performing 
the  experiments  in  the  inoculation  of  blood  and 


YELLOW   FEVER   COMMISSION  267 

serum  described  in  Chapter  VII.  These  experi- 
ments have  already  been  dwelt  upon  at  some 
length,  but  the  present  seems  to  be  the  most  ap- 
propriate place  to  relate  an  incident  which  shows 
how  greatly  the  final  success  of  the  yellow  fever 
work  was  due  to  Dr.  Carroll's  force  of  character. 

The  serious  nature  of  the  experimental  cases  at 
Las  Animas  Hospital  and  the  occurrence  of  two 
deaths  had  alarmed  Dr.  Guiteras  and  Dr.  Finlay 
and  had  occasioned  no  little  excitement  in  the 
public  mind.  Such  a  condition  of  things  would 
have  deterred  many  men  from  further  action,  but 
Dr.  Carroll  was  of  a  different  fibre.  To  be  driven 
from  the  field  of  battle  just  as  the  crowning  suc- 
cess of  his  investigations  was  at  hand  was  not  a 
part  of  his  plan;  his  continuance,  however,  was 
rendered  somewhat  difficult  by  the  fact  that  Dr. 
Reed,  disturbed  by  the  exaggerated  reports  which 
reached  him  through  the  press,  and  hampered  in 
his  judgment  by  the  disadvantage  of  being  at  a 
distance,  wrote  to  advise  against  further  experi- 
ments upon  human  beings,  and  Dr.  Carroll  was 
forced  to  stand  alone.  The  correspondence  be- 
tween them  at  this  juncture  makes  it  plain  that  the 
Yellow  Fever  Commission  owes  the  completion  of 
the  final  stage  in  its  work  at  this  particular  time 
to  Dr.  Carroll's  wisdom  and  self-reliance. 

On  August  1 8,  Dr.  Carroll  wrote  to  Dr.  Reed 


268    WALTER   REED   AND   YELLOW   FEVER 

as  follows  concerning  the  serious  character  of  the 
yellow  fever  cases  then  under  Dr.  Guiteras'  care : 

LAS  ANIMAS  HOSPITAL,  HAVANA, 

Aug.  1 8,  1901. 

MY  DEAR  DOCTOR:  The  first  fatal  case  of  experi- 
mental fever  is  now  on  record.  Dr.  Guiteras'  second 
case  died  at  2  P.  M.  this  morning,  on  the  sixth  day  of 
the  disease,  after  having  had  black  vomit,  with  delirium, 
bloody  stools,  etc.  .  .  .  Guiteras  declined  to  permit  the 
case  to  be  autopsied,  for  fear  of  its  effect  upon  the  Span- 
iards. The  morgue  is  situated  adjoining  to  and  con- 
tinuous with  the  laboratory,  and  is  completely  screened 
with  slatted  windows.  Dr.  Gorgas  came  out  later  and 
overcame  the  objections,  so  I  made  the  autopsy  in  Dr. 
Guiteras'  presence,  and  with  his  assistance.  .  .  . 

Their  third  case  has  black  vomit,  hiccough,  convul- 
sive movements,  delirium,  and  will  die  within  twenty- 
four  hours.  The  fourth  and  fifth  cases  are  down,  the 
former  very  mild,  in  the  person  of  Dr.  G.'s  laboratory 
assistant,  and  the  latter,  a  Miss  Mears,  a  nurse,  came 
down  to-day.  So  far  she  seems  to  be  one  of  only  mod- 
erate severity.  ...  In  the  third  case  there  was  no  rise 
of  temperature  until  within  the  first  three  hours  of  the 
sixth  day  of  the  disease.  I  was  prepared  to  take  blood 
from  this  individual  on  the  second  day,  but  Guiteras 
would  not  let  me  bite  him  with  the  six  insects  which  I 
had  ready  for  the  purpose.  To  tell  the  truth,  they  ap- 
pear to  be  panic-stricken  at  the  positive  character  of 
their  results,  and  they  think  all  biting  should  be  stopped. 
Very  sincerely  yours, 

JAMES  CARROLL. 


269 

This  letter  crossed  the  following,  coming  from 
Dr.  Reed  to  Dr.  Carroll: 

BLUE  RIDGE  SUMMIT,  PA., 

Aug.  23,  1901. 

MY  DEAR  DOCTOR:  Guiteras  and  my  good  friend 
Dr.  Finlay  must  have  been  having  a  devil  of  a  time 
with  their  patients,  as  far  as  I  can  judge  by  the  ac- 
counts in  the  daily  papers.  I  wonder  what  they  think 
of  the  "  mild  "  character  of  the  attacks  conveyed  by 
these  insects !  There  did  not  appear  to  be  much  "  im- 
munity conveyed  by  these  insects."  Really,  this  sacrifice 
of  life  was  so  unnecessary,  in  my  opinion.  I  was  certain 
that  somebody  was  bound  to  be  killed  before  the  work 
was  completed. 

You  say  "  prospects  favourable."  And  this  leads  me 
to  strongly  advise  against  further  experiments  on  human 
beings.  Our  work  has  been  too  good  to  be  marred  now 
by  a  death.  As  much  as  I  should  like  to  know  whether 
the  filtrate  will  convey  the  disease,  I  should  advise 
against  it.  Infect  as  many  insects  as  you  can  for  further 
sectioning,  and  get  other  information  about  the  epidemic 
at  Santiago  de  las  Vegas,  and  send  me  as  soon  as  you 
can. 

Please  extend  my  sympathy  to  Drs.  G.  and  Finlay, 
with  my  kindest  regards.  I  return  to  Washington  Sep- 
tember I. 

Yours  sincerely, 

WALTER  REED. 

It  will  be  remembered  that  in  all  the  inocula- 
tion experiments  carried  on  at  Camp  Lazear  no 


270    WALTER   REED   AND   YELLOW   FEVER 

fatal  case  of  experimental  yellow  fever  had  oc- 
curred, and  Dr.  Carroll  was  convinced  that  it  was 
entirely  possible  for  him  to  continue  the  experi- 
ments necessary  to  the  completion  of  his  work 
without  unjustifiable  risk  to  life,  the  death  at  Las 
Animas  being  due,  in  his  opinion,  to  special  causes 
which  it  would  be  within  his  power  to  control.  To 
abandon  his  researches  simply  because  the  public 
mind  was  unduly  agitated  was  not  to  be  thought 
of.  Accordingly,  during  the  interval  between  the 
despatch  of  his  letter  to  Dr.  Reed  and  the  receipt 
of  the  one  which  crossed  it,  he  proceeded  with 
the  work  along  the  proposed  lines,  writing  again 
on  August  22  to  keep  Dr.  Reed  informed  of  his 
proceedings.  About  a  week  later  he  received  the 
following  letter  from  Reed: 

BLUE  RIDGE  SUMMIT,  PA., 

Aug.  27,  1901. 

MY  DEAR  CARROLL  :  I  have  your  letters  of  the  1 8th 
and  the  23d,  both  of  which  reached  me  by  this  morn- 
ing's mail.  It  is  needless  to  say  that  both  are  of  extreme 
interest.  Certainly,  Guiteras  should  now  be  satisfied  with 
his  proof  of  the  mosquito  theory.  Six  out  of  seven  cases, 
with  two  fatal,  is  evidence  that  should  convince  even 
Wasdin.  I  wrote  you  a  few  days  ago  advising  against 
further  experiments  on  human  beings,  in  view  of  these 
fatal  cases.  From  the  tenor  of  your  last  letter,  however, 
I  see  that  you  have  made  all  preparations  to  go  ahead 
with  the  observations  as  determined  by  us  at  Washing- 


YELLOW   FEVER   COMMISSION  271 

ton,  and  I  hardly  know  what  to  say.  I  will  suggest  that, 
inasmuch  as  the  injection  of  the  blood  has  given  us 
four  positive  results,  you  limit  your  observations  to  the 
injection  of  the  serum  without  making  controls  injected 
with  unfiltered  blood.  If  the  filtrate  proves  negative  in, 
say,  three  or  four  cases,  that  would  decide  the  point 
conclusively. 

Of  course,  since  Guiteras  denied  you  the  chance  to 
obtain  the  blood,  I  suppose  you  must  obtain  your  first 
subject  by  means  of  the  mosquito's  bite,  unless  there  are 
cases  at  Havana.  What  could  have  been  Guiteras'  ob- 
jection to  your  applying  mosquitoes  to  his  cases?  .  .  . 
I  shall  await  your  results  with  the  greatest  interest. 

Please  remember  me  kindly  to  Majors  Havard  and 
Gorgas,  and  to  Agramonte  when  you  see  him. 

Sincerely  yours, 

WALTER  REED. 

This  letter  was  written  on  August  27,  and  after 
writing  it  Dr.  Reed  made  up  his  mind,  on  further 
reflection,  that  it  would  be  unwise  to  interfere 
with  Dr.  Carroll's  plans,  considering  that  since  he 
was  on  the  spot  he  was,  after  all,  the  best  judge  as 
to  the  propriety  of  making  further  experiments 
upon  human  beings.  On  August  29,  therefore,  he 
cabled  to  Dr.  Carroll  as  follows: 

WASHINGTON,  D.  C., 

Aug.  29,  1901. 

Consult  Havard.  Use  your  best  judgment  in  future. 

REED. 


272    WALTER   REED  AND  YELLOW   FEVER 

This  despatch  was  received  by  Dr.  Carroll  on 
the  same  day  as  the  letter  written  on  the  27th,  and 
was  a  great  relief  to  his  mind.  He  had  some  diffi- 
culty at  first  in  producing  the  necessary  experi- 
mental cases;  in  spite  of  delay  from  this  cause, 
however,  as  well  as  hindrances  of  various  kinds, 
among  them  the  accident  to  the  suction  pump, 
already  described,  he  persevered  according  to  the 
proposed  plans  and  completed  the  work  in  the 
latter  part  of  October.  Dr.  Reed's  last  letter  to  him 
before  his  return  home  shows  emphatically  how 
satisfactory  were  the  results  of  his  judgment  at 
this  final  stage  of  the  yellow  fever  work: 

SURGEON  GENERAL'S  OFFICE, 
WASHINGTON,  D.  C.,  Oct.  26,  1901. 
MY  DEAR  DOCTOR:  I  have  just  received  your  letter 
of  the   22d,   and  hasten  to   congratulate   you  on   the 
thorough  manner  in  which  you  have  accomplished  the 
task  assigned  you.  The  results  could  not  be  better,  and 
throw  a  flood  of  light  on  the  etiology  of  yellow  fever. 
.     .     We  can  now  go  ahead  and  submit  a  contri- 
bution on  the  etiology  of  yellow  fever.  This  we  must 
do  promptly,  after  we  have  discussed  all  of  the  later 
results.  .  .  . 

Again  congratulations.  Hoping  to  see  you  soon, 

Very  sincerely  yours, 

W.  REED. 

The  published  report  of  these  experiments  is  the 
last  paper  issued  under  the  joint  names  of  Reed 


YELLOW   FEVER   COMMISSION  273 

and  Carroll.  With  its  appearance  the  official  pub- 
lications of  the  Commission  ended,  but  Dr.  Car- 
roll's interest  in  the  subject  has  continued  un- 
abated, and  he  has  embodied  the  knowledge 
acquired  during  his  unique  experiences  in  several 
papers  of  the  greatest  interest.  The  first  of  these, 
on  "  The  Treatment  of  Yellow  Fever,"  published 
in  July,  1902,  is  of  special  interest,  because  it  is 
the  first  discussion  of  the  therapeutics  of  the  dis- 
ease since  its  aetiology  has  been  correctly  known. 
After  reviewing  all  the  methods  of  treatment  em- 
ployed both  in  ancient  and  more  modern  times, 
Dr.  Carroll  lays  down  the  following  general 
principles:  2 

In  yellow  fever  we  are  dealing  with  a  disease  of 
short  duration  and  one  that  tests  severely  the  vital 
powers  of  the  patient.  I  believe,  however,  that  in 
previously  healthy,  non-debilitated  subjects,  free  from 
organic  lesions,  the  mortality  can  be  reduced,  practi- 
cally to  zero,  by  careful  and  judicious  treatment  insti- 
tuted at  the  incipiency  of  the  attack.  On  the  other 
hand,  if  there  be  present  debility  from  any  cause, 
anaemia,  organic  lesions  of  the  heart,  liver,  or  kidneys, 
the  outlook  is  always  serious  and  recovery  doubtful. 
The  treatment  must  be  essentially  eliminative  and  sup- 
porting, with  the  incidental  use  of  measures  tending  to 
reduce  hyperpyrexia,  relieve  pain,  and  remove  internal 
congestions. 

2  Jour.  Amer.  Med.  Assoc.,  July  19,  1902. 


274    WALTER   REED   AND   YELLOW   FEVER 

"  The  lesions  and  symptoms,"  he  continues,  "  are 
produced  by  a  powerful  toxin  circulating  in  the 
blood  and  tissue  fluids.  This  poison  appears  to  act 
with  greatest  intensity  upon  the  liver,  and  next 
upon  the  kidneys."  After  giving  an  able  description 
of  the  conspicuous  pathological  lesions  produced 
by  the  disease,  Dr.  Carroll  proceeds  as  follows: 

The  primary  indication  in  the  treatment  of  yellow 
fever  is  to  remove  the  immediate  cause  of  the  condition 
present,  viz.,  the  toxin.  This  is  best  and  most  expedi- 
tiously  effected  through  the  normal  channel,  with  the 
urinary  secretion,  aided  by  the  moderately  free  action 
of  the  skin  and  moderate  depletion  of  the  digestive 
tract  by  the  use  of  mild  saline  cathartics.  With  the 
evacuation  of  these  fluids  and  the  toxin  they  contain, 
the  symptoms  abate — speaking  of  the  early  stage — 
and  the  stomach  will  retain  an  increased  amount  of 
fluid  to  replace  that  which  has  been  removed.  Care 
should  be  taken  to  maintain  one  or  more  of  these  func- 
tions throughout  the  attack,  sustaining  the  patient's 
strength  by  the  judicious  use  of  appropriate  stimulants. 
It  is  much  to  be  regretted  that  we  have  no  means  of 
acting  directly  on  the  liver. 

After  reviewing  the  various  means  of  fulfilling 
these  indications  in  detail,  Dr.  Carroll  takes  up 
the  question  of  nutrition  during  the  disease: 

The  nutrition  of  the  patient  is  a  subject  well  worthy 
of  consideration.  Food  is  frequently  withheld  for  vary- 
ing periods,  from  three  to  five  days  or  a  week;  in  my 


YELLOW   FEVER   COMMISSION  275 

own  case,  I  think  for  at  least  eight  days  nothing  was 
allowed  but  water,  Apollinaris,  ice,  and  champagne. 
Now,  during  all  this  time  certain  cells  of  the  body  are 
functioning  and  using  up  their  own  protoplasm,  for  in 
conditions  of  anaemia  or  malnutrition  and  in  the  in- 
fectious diseases,  we  know  that  the  cells  of  the  vital 
organs  undergo  degeneration  and  often  necrosis,  from 
want  of  proper  material.  In  specific  fevers  the  functions 
of  some  of  the  cells  are  consumed  in  the  performance 
of  these  functions  and  converted  into  waste  material 
and  end-products  which  add  to  the  general  intoxication. 
Physiologists  teach  us  that  there  are  certain  foods  that 
will  prevent  this  by  saving  their  proteid  constituents. 
Among  these  are  gelatine,  fat,  and  non-proteid  foods, 
the  latter  of  which,  in  the  form  of  olive  oil,  has  been 
used  with  marked  success  by  Spanish  physicians  in  the 
treatment  of  yellow  fever.  .  .  .  The  rationale  of  this 
treatment  appears  to  be  that  the  oil  is  highly  nutritious, 
a  proteid  saver,  and  is  readily  absorbed  by  the  epithelial 
and  endothelial  cells  of  the  capillaries.  In  this  way  the 
integrity  of  the  latter  is  preserved  and  the  haemorrhage 
prevented.  Pathology  teaches  us  that  when  there  is 
capillary  blood  stasis,  haemorrhage  soon  takes  place 
from  deprivation  of  nourishment,  the  endothelial  cells 
of  the  capillaries  being  nourished  by  the  blood  that 
circulates  within  the  vessels.  This  suggests  the  early 
administration  of  olive  oil  in  emulsion  with  lime  water. 

Finally,  Dr.  Carroll  takes  up  the  question  of 
decrease  in  the  elimination  of  urea  as  follows: 

The  early  involvement  of  the  liver,  as  indicated  by 
the  early  lesion  in  the  duodenum,  naturally  suggests  an 


276    WALTER   REED   AND   YELLOW   FEVER 

equally  early  defect  in  the  functioning  power  of  the 
liver  in  the  elaboration  of  urea.  This  deficiency,  which 
must  sooner  or  later  become  marked,  is  manifested  in 
the  failure  of  the  kidneys  to  secrete  the  normal  amount 
of  urine.  As  the  rate  of  elimination  by  these  organs 
increases  normally  with  an  increase  in  the  urea  in  the 
blood,  it  would  seem  justifiable  to  supply  the  defect  by 
the  medicinal  administration  of  urea,  either  through  the 
stomach  or  by  hypodermic  injection  as  soon  as  the  ordi- 
nary remedies  cease  to  have  the  ordinary  effect.  The 
injection  of  urea  into  the  blood  soon  evokes  a  very 
copious  secretion  of  urine,  even  if  previously  to  the  in- 
jection the  secretion  had  been  at  a  standstill.  We  can 
hardly  do  better  than  follow  Nature's  method  of  stimu- 
lating these  organs  to  perform  their  normal  functions. 
And  the  danger  of  an  excessive  accumulation  of  urea 
in  the  blood  must  be  very  slight  in  a  condition  where 
the  substance  is  manifestly  deficient.  .  .  . 

In  my  opinion  [he  concludes],  the  services  of  trained 
female  nurses  are  indispensable  to  secure  the  very  best 
results.  They  should  be  under  strict  discipline,  and  the 
tour  of  duty  with  patients  who  are  seriously  ill  should 
be  eight  hours  in  the  twenty-four. 

In  1903  Dr.  Carroll  published  two  more  papers. 
One  of  these,  on  the  "  History,  Cause,  and  Mode 
of  Transmission  of  Yellow  Fever,  and  the  Occur- 
rence of  Similar  Types  of  Fatal  Fevers  in  Places 
where  Yellow  Fever  is  not  Known  to  Have  Ex- 
isted," 3  contains  an  interesting  review  of  the  liter- 

8  Jour.  Military  Surg.,  1903. 


YELLOW  FEVER   COMMISSION  277 

ature  of  the  disease  which  it  will  well  repay  any- 
one investigating  the  subject  to  read : 

The  other  paper  is  "  The  Transmission  of  Yel- 
low Fever."  4  In  this  article,  when  speaking  of 
the  possibility  of  controlling  yellow  fever,  Dr. 
Carroll  says: 

The  greatest  obstacle  to  the  control  of  the  disease 
is  the  failure  to  recognise  the  first  cases,  when  they  are 
not  accompanied  by  black  vomit.  Some  of  these  cases 
are  so  mild  in  character  that  no  physician  would  dare 
to  pronounce  them  yellow  fever  unless  he  knew  the  dis- 
ease to  be  prevailing  at  the  time.  Susceptible  persons 
visiting  at  the  house,  or  living  in  adjoining  houses, 
would  be  bitten  and  develop  the  disease  in  near  or 
distant  localities  several  weeks  later,  forming  secondary 
foci  of  infection.  From  these  secondary  foci,  tertiary 
foci  would  in  time  develop.  The  diagnosis  of  bilious 
remittent  fever,  dengue,  etc.,  would  serve  to  cover  the 
earlier  cases  until  the  appearance  of  black  vomit,  by 
which  time  the  infection  would  have  become  more  or 
less  widely  disseminated.  Such  is  the  history  of  many 
outbreaks. 

Another  of  Dr.  Carroll's  later  publications  is 
entitled  "  A  Brief  Review  of  the  Etiology  of  Yel- 
low Fever."  This  paper  has  been  very  largely 
drawn  upon  for  the  material  in  some  of  the  fore- 
going chapters,  and  I  will  not,  therefore,  stop  to 
consider  it  here,  except  in  one  particular.  In  con- 
*  Jour.  Amer.  Med.  Assoc.,  May  23d,  1903. 


278    WALTER   REED  AND   YELLOW   FEVER 

eluding,  Dr.  Carroll  makes  reference  to  some  ex- 
periments, performed  a  hundred  years  ago,  which 
have  great  historic  interest  in  the  light  of  our 
present  knowledge. 

They  were  made  by  a  student  of  the  University  of 
Pennsylvania,  Stubbins  Ffirth  by  name,  who  embodied 
a  description  of  them  in  a  graduation  thesis  presented 
on  June  6,  1804.  During  the  epidemics  of  1802  and 
1803  in  Philadelphia,  Ffirth  made  numerous  attempts 
to  inoculate  himself  by  depositing  fresh  black  vomit 
and  blood  obtained  from  patients  in  the  early  stages 
of  the  disease  into  incisions  made  in  his  arms  and  legs. 
Besides  numerous  other  experiments  he  inserted  four 
drops  of  such  serum  into  an  incision  in  his  leg.  One 
must  read  this  interesting  treatise  in  order  to  appreciate 
fully  the  determination  of  the  investigator,  who  admin- 
istered black  vomit  to  animals,  injected  it  into  his  own 
circulation,  and  deposited  it  in  his  own  tissues.  He  in- 
haled the  fumes  of  six  ounces  of  this  material  which 
he  heated  over  a  sand-bath  in  a  small  room;  the  resi- 
due he  made  into  pills  and  swallowed.  Failing  in  this, 
he  further  tried  to  inoculate  himself  with  blood  serum, 
saliva,  perspiration,  bile,  and  urine,  and  finally  concluded 
that  yellow  fever  was  neither  infectious  nor  contagious. 
Since  the  French  Commission  has  told  us  that  o.i  cc. 
of  virulent  serum  is  sufficient  to  infect,  we  can  safely 
say  that  Stubbins  Ffirth  came  very  near  to  proving  the 
inoculability  of  yellow  fever  more  than  a  century  ago. 

It  is  greatly  to  be  hoped  that  Dr.  Carroll  will 
continue  the  line  of  investigation  in  which  he  has 


YELLOW   FEVER   COMMISSION  279 

achieved  such  signal  success.  The  fact  that  the 
specific  germ  of  yellow  fever  is  almost  certainly 
ultra-microscopic,  makes  it  very  improbable  that 
we  shall  discover  it,  at  least  with  the  means  now  at 
our  command.  But  there  are  great  possibilities  for 
investigation  as  to  the  transmission  of  other  dis- 
eases through  the  medium  of  insects,  and  the  es- 
tablishment of  prophylaxis  along  lines  suggested 
by  such  demonstrations.  In  this  connection  it  is 
interesting  to  learn  from  Dr.  Carroll  that  Dr. 
Reed  firmly  believed  that  smallpox  is  conveyed 
by  a  biting  insect  of  some  kind,  and  that  he  and 
Dr.  Carroll  made  some  (apparently  ineffectual) 
attempts  to  variolate  calves  by  causing  them  to  be 
bitten  by  bed-bugs  that  had  previously  been  ap- 
plied to  patients  suffering  with  smallpox. 

I  cannot  close  this  little  memoir  of  Dr.  Carroll 
more  suitably  than  by  quoting  from  an  address 
delivered  by  Dr.  J.  W.  Pilcher,  U.  S.  A.,  before 
the  Association  of  Military  Surgeons  touching 
"  The  Duty  of  the  Physician  to  the  Public,"  in 
which  he  alludes  to  Dr.  Carroll  as  follows: 

"  While  stationed  in  the  Far  West  some  years  ago, 
my  attention  was  attracted  by  the  unusual  ability  of  a 
young  soldier  who  had  come  under  my  command.  Be- 
lieving that  a  higher  fate  might  be  in  store  for  him 
than  that  of  an  enlisted  man  of  the  army,  I  began  in- 
structing him  in  the  art  of  medicine.  He  became  very 


280    WALTER   REED  AND   YELLOW   FEVER 

much  interested  in  .the  subject,  and  under  my  direction 
pursued  the  work  until  he  acquired  the  degree  of  Doctor 
of  Medicine  and  ultimately  became  employed  as  assis- 
tant in  the  Army  Medical  Museum  at  Washington. 
When  the  entrance  of  our  army  into  Cuba  made  the  con- 
quest of  yellow  fever  one  of  the  most  important  forces 
to  be  accomplished,  he  and  his  chief,  the  late,  lamented 
Walter  Reed,  determined  to  enter  upon  a  series  of  in- 
vestigations in  that  direction.  The  proper  execution  of 
the  work  demanded  animal  experimentation  of  the 
highest  type.  Humanity  must  be  the  subject.  No  crea- 
ture of  a  lower  grade  would  suffice.  In  the  grandeur  of 
self-sacrifice  this  glorious  fellow  submitted  himself  to 
the  bite  of  a  stegomyia  fasciata  from  the  sick  room  of 
a  yellow  fever  patient.  The  disease  promptly  developed 
in  its  most  severe  form.  .  .  .  Only  the  most  intimate 
care  of  the  ablest  physicians  based  upon  a  constitution 
strengthened  by  correct  living  and  good  habits  saved 
him  from  the  fell  destroyer. 

"  From  this  experiment  grew  that  wonderful  series 
of  studies  upon  which  has  been  based  the  true  theory 
of  the  control  of  yellow  fever.  I  refer  to  the  particular 
case  because  I  am  prouder  than  I  can  state  that  the  re- 
sults of  my  teaching  have  brought  into  the  profession 
a  man  so  highly  typical  of  the  best  in  practice  and  in 
experimentation.  That  this  example  was  followed  by 
Jesse  Lazear,  in  whom  the  experiment  resulted  fatally 
and  whose  brilliant  young  life  was  sacrificed  for  the 
benefit  of  the  people  of  America,  is  but  an  additional 
demonstration  of  the  great  danger  which  this  young 
physician  incurred,  without  hope  of  reward,  for  the 
benefit  of  the  human  race." 


YELLOW   FEVER   COMMISSION  281 

I  subjoin  a  list  of  the  articles  which  Dr.  Carroll 
has  published  independently  on  the  subject  of 
yellow  fever. 

LIST  OF  DR.  CARROLL'S  INDEPENDENT  CONTRIBUTIONS 
TO  THE  LITERATURE  OF  YELLOW  FEVER. 

"  The  Treatment  of  Yellow  Fever."  Jour.  Amer. 
Med.  Assoc.,  July  19,  1902. 

"  The  Transmission  of  Yellow  Fever."  Jour.  Amer. 
Med.  Assoc.,  May  23,  1903. 

"The  Etiology  of  Yellow  Fever:  an  Addendum." 
Jour.  Amer.  Med.  Assoc.,  Nov.  28,  1903. 

"  Remarks  on  the  History,  Cause,  and  Mode  of 
Transmission  of  Yellow  Fever,  etc."  Jour.  Assoc.  Mili- 
tary Surgeons,  1903. 

"  A  Brief  Review  of  the  Etiology  of  Yellow  Fever." 
N.  Y.  Med.  Jour,  and  Phil.  Med.  Jour,  (consol.), 
iFeb.  6  and  13,  1904. 

"Yellow  Fever:  a  Popular  Lecture."  Amer.  Med., 
June  3,  1905. 

"  Lessons  to  be  Learned  from  the  Present  Outbreak 
of  Yellow  Fever."  Jour.  Amer.  Med.  Assoc.,  Oct.  7, 
1905. 

''  Remarks  on  the  Epidemics  of  Yellow  Fever  in  Bal- 
timore." Old  Maryland,  Feb.,  1906. 

"  Without  Mosquitoes  There  Can  Be  No  Yellow 
Fever."  American  Medicine,  March  17,  1906. 

JESSE  W.  LAZEAR 

Dr.  Jesse  W.  Lazear,  the  third  member  of  the 
'Army  Commission,  was  born  in  Baltimore  on  May 


282    WALTER   REED  AND   YELLOW  FEVER 

2,  1866.  His  early  education  was  received  at  Trin- 
ity Hall,  a  private  school  in  Washington,  Pennsyl- 
vania, from  which  he  entered  the  Johns  Hopkins 
University,  graduating  in  1889.  He  then  studied 
medicine  at  Columbia  University  and  was  gradu- 
ated there  in  1892,  after  which  he  served  for  two 
years  at  the  Bellevue  Hospital,  New  York.  When 
his  hospital  service  ended  he  spent  a  year  in  Eu- 
rope, part  of  which  was  passed  at  the  Pasteur 
Institute,  in  Paris.  On  his  return  to  this  country  he 
was  appointed  bacteriologist  to  the  medical  staff 
of  the  Johns  Hopkins  Hospital,  and  also  held  the 
position  of  assistant  in  clinical  microscopy  in  the 
University. 

Much  of  Dr.  Lazear's  time  after  he  was  gradu- 
ated in  medicine  was  spent  in  research,  and  during 
his  residence  at  Bellevue  he  succeeded  in  isolating, 
for  the  first  time,  the  diplococcus  of  Neisser  in 
pure  culture  from  the  circulating  blood,  in  a  case 
of  ulcerative  endocarditis ;  he  followed  up  this  dis- 
covery by  investigations  into  problems  connected 
with  malarial  parasites.  He  was  the  first  person 
in  this  country  to  confirm  and  elaborate  the  studies 
of  Romanovsky  and  others  concerning  the  intimate 
structures  of  the  haematozoa  of  malaria,  although 
his  work  on  the  subject  was,  unfortunately,  not 
published  until  after  his  death.  He,  together  with 
Woolley  and  Thayer,  was  first  in  this  country  to 


JESSE    W.    LAZ.EAR,    M.D. 

Member  of  the  U.  S.  A.  Yellow    Fever  Commission,   who  laid 
down  his  life  on  the  field  of  service 


YELLOW   FEVER   COMMISSION  283 

confirm,  in  part,  the  work  of  Ross  and  the  Italians 
on  the  mosquito  cycle  of  the  malarial  parasite. 

The  years  spent  in  studies  of  this  description 
had,  of  course,  peculiarly  fitted  Dr.  Lazear  for  the 
work  which  the  Yellow  Fever  Commission  was 
instituted  to  conduct,  and  he  was  appointed  to  it 
with  the  rank  of  acting  assistant  surgeon.  When 
Dr.  Reed,  in  company  with  Dr.  Carroll,  reached 
Cuba,  Dr.  Lazear  had  been  on  the  island  several 
months,  during  which  time  he  had  observed  a 
number  of  cases  of  yellow  fever,  performing  au- 
topsies, when  opportunity  afforded,  and  taking 
cultures.  He  had  studied  many  films  of  blood  from 
yellow  fever  patients,  and  was  prepared  to  say 
with  confidence  that  cultures  and  blood  examina- 
tions promised  nothing  of  special  importance. 

Not  long  after  the  arrival  of  the  other  members 
of  the  Commission  Dr.  Lazear  applied  to  himself 
a  mosquito  of  the  genus  stegomyia,  which  had  bit- 
ten a  yellow  fever  patient  some  days  previously. 
The  results,  however,  in  this  instance  were  nega- 
tive. About  a  month  later,  during  Dr.  Reed's  ab- 
sence in  the  United  States,  Dr.  Lazear  allowed  a 
mosquito,  which  had  chanced  to  alight  on  his  hand, 
to  take  its  fill.  This  occurrence  took  place  in  the 
yellow  fever  ward  of  Las  Animas  Hospital,  in  the 
suburbs  of  Havana,  on  September  13.  He  did  not 
at  the  time  believe  that  the  insect  which  had  bitten 


284    WALTER   REED  AND   YELLOW   FEVER 

him  was  a  Culex  Fasciatus,  but,  as  he  expressed  it, 
"a  common,  ordinary  brown  mosquito";  never- 
theless, as  it  was  not  at  that  time  known  whether 
one  genus,  or  more  than  one,  was  capable  of  con- 
veying the  disease,  he  may  be  said  to  have  volun- 
tarily accepted  all  the  chances  that  went  with  the 
inoculation. 

Five  days  later,  during  the  night  of  September 
1 8,  he  was  seized  with  a  chill,  followed  in  a  few 
hours  by  another.  Dr.  Carroll,  who  was  at  that 
time  recovering  from  his  own  attack  of  yellow 
fever,  examined  Dr.  Lazear's  blood  twice  for  ma- 
larial parasites,  and  as  the  results  were  negative 
and  the  clinical  symptoms  made  the  diagnosis 
fairly  secure,  he  was  removed  to  the  yellow  fever 
isolation  camp.  Before  his  removal  he  made  over 
to  Dr.  Carroll  his  notes  covering  all  the  attempts 
at  mosquito  inoculation,  and  told  him  of  his  per- 
sonal experience  concerning  which  there  was  no 
record.  For  three  days  of  his  illness  he  held  his 
own,  but  at  the  end  of  this  time  the  dreaded  black 
vomit  made  its  appearance,  a  symptom  the  sig- 
nificance of  which  he  himself  knew  only  too  well. 
"  I  shall  never  forget,"  says  Dr.  Carroll  in  his 
published  account  of  Dr.  Lazear's  illness,  "  the 
expression  of  alarm  in  his  eyes  when  I  last  saw 
him  alive  in  the  third  or  fourth  day  of  his  illness. 
The  spasmodic  contractions  of  his  diaphragm  in- 


YELLOW   FEVER   COMMISSION  285 

dicated  that  black  vomit  was  impending,  and  he 
fully  appreciated  their  significance."  Four  days 
later  he  died,  leaving  a  widow  and  two  little  chil- 
dren, the  younger  of  whom  he  had  never  seen. 

"  Thus  ended,"  says  Dr.  Carroll,  "  a  life  of  bril- 
liant promise  at  the  early  age  of  thirty-four.  Dr. 
Lazear  died  that  his  fellow-men  might  live  in  com- 
fort and  happiness.  .  .  .  It  is  no  exaggeration 
to  say  that  hundreds,  nay,  perhaps  thousands,  in 
the  Southern  States  owe  their  lives,  certainly  their 
prosperity,  to  the  results  of  the  work  in  which  he 
was  engaged,  and  for  which  he  and  his  family 
have  paid  such  a  fearful  penalty.  The  world  lost 
in  him  a  benefactor;  the  profession  a  man  of  high 
attainments,  noble  character,  and  lovable  disposi- 
tion; words  cannot  measure  the  loss  to  his  widow 
and  orphans."  These  words  are  taken  from  Dr. 
Carroll's  address  at  the  unveiling  of  the  memorial 
tablet  to  Dr.  Lazear  at  the  Johns  Hopkins  Hos- 
pital, and  I  ought  not  to  close  this  tribute  to  his 
memory  without  quoting  from  the  remarks  of  his 
friend  and  co-worker,  Dr.  W.  B.  Thayer. 

"  I  wish,"  Dr.  Thayer  said,  "  especially  for 
the  younger  men  here,  that  I  might  be  able  to 
picture  to  you  Lazear  as  a  man  and  companion. 
Quiet,  retiring,  and  modest  almost  to  a  fault,  he 
was  yet  a  manly  man  with  a  good,  vigorous  tem- 
per, well  controlled,  and  a  rare  physical  courage, 


286    WALTER   REED   AND   YELLOW   FEVER 

with  a  deep  love  of  his  profession,  and  an  ardent 
desire  to  make  adequate  contributions  to  its  ad- 
vance. .  .  .  When  the  news  of  his  sad  death 
became  known,  there  were  those  who  blamed  what 
they  regarded  as  unjustified  temerity;  who  felt  that 
such  risks  were  not  for  married  men.  With  these  I 
cannot  agree.  No  man  loved  his  family  more  than 
Lazear,  but  he  was  engaged  in  a  great  work — and 
he  knew  it — in  a  work  where  at  the  moment  no 
substitute  could  take  his  place.  Lazear  saw  his 
duty  clearly,  and  where  he  saw  his  duty  fear  and 
doubt  could  not  enter  in.  A  few  well-known  lines 
of  Emerson's  tell  the  story: 

Though  love  repine  and  reason  chafe, 
There  comes  a  voice  without  reply. 

'Tis  man's  perdition  to  be  safe, 

When  for  the  truth  he  ought  to  die." 

Dr.  Lazear  laid  down  his  life  before  the  Yellow 
Fever  Commission  had  well  entered  upon  their 
work,  so  early  in  its  career,  indeed,  that  his  name 
appears  in  only  one  of  its  published  reports,  the 
"  Preliminary  Note  on  the  Etiology  of  Yellow 
Fever."  Nevertheless,  although  his  untimely  death 
deprived  him  of  a  full  share  in  the  brilliant  re- 
sults they  achieved,  he  did  heroic  service  in  the 
cause.  I  do  not  think  I  can  close  this  brief  memo- 
rial more  appropriately  than  by  citing  the  tribute 
paid  him  by  his  friend  and  colleague,  Dr.  Reed, 


YELLOW   FEVER   COMMISSION  287 

when   addressing   the   Medical   and   Chirurgical 
Faculty  of  Maryland  in  April,  1901. 

Before  proceeding  to  the  discussion  of  my  subject,  it 
is  fitting  that  I  should  pay  brief  tribute  to  the  memory 
of  a  former  member  of  this  Faculty,  the  late  Dr.  Jesse 
W.  Lazear,  United  States  Army.  I  can  hardly  trust 
myself  to  speak  of  my  late  colleague,  since  the  mention 
of  his  name  brings  back  such  scenes  of  anxiety  and  de- 
pression as  one  recalls  only  with  pain.  Along  with 
these  sad  memories,  however,  come  other  recollections 
of  a  manly  and  fearless  devotion  to  duty  such  as  I  have 
never  seen  equalled.  In  the  discharge  of  the  latter,  Dr. 
Lazear  seemed  absolutely  tireless  and  quite  oblivious 
of  self.  Filled  with  an  earnest  enthusiasm  for  the  ad- 
vancement of  his  profession  and  for  the  cause  of  sci- 
ence, he  let  no  opportunity  pass  unimproved.  Although 
the  evening  might  find  him  discouraged  over  the  diffi- 
culties at  hand,  with  the  morning's  return  he  again 
took  up  the  task  full  of  eagerness  and  hope.  During 
a  service  of  less  than  a  year  in  Cuba  he  won  the  good- 
will and  respect  of  his  brother  officers  and  the  affection 
of  his  immediate  associates.  Almost  at  the  beginning 
of  what  promised  to  be  a  life  full  of  usefulness  and 
good  works  he  was  suddenly  stricken,  and,  dying, 
added  one  more  name  to  that  imperishable  roll  of 
honour  in  which  none  others  belong  than  martyrs  to 
the  cause  of  humanity.  It  is  my  own  earnest  wish  that, 
whatever  credit  may  hereafter  be  given  to  the  work 
of  the  American  Commission  in  Cuba,  during  the  past 
year,  the  name  of  my  late  colleague,  Dr.  Lazear,  may 
be  always  associated  therewith. 


288    WALTER   REED   AND   YELLOW   FEVER 

Dr.  Lazear's  remains  lie  in  the  Loudon  Park 
Cemetery  at  Baltimore.  A  memorial  tablet,  erected 
by  his  friends  at  the  Johns  Hopkins  Hospital,  bears 
this  inscription,  by  President  Eliot: 

In  memory  of 
JESSE   WILLIAM    LAZEAR, 

born  May  2,  1866,  at  Baltimore, 

Graduated  in  Arts  at 

the  Johns  Hopkins  University  in  1889; 

and  in  Medicine  at  Columbia  University  in  1892. 

In  1895-96  Assistant  Resident  Physician 

in  the  Johns  Hopkins  Hospital. 
Member  of  the  Yellow  Fever  Commission  in  1900 

with  the  rank  of  Acting  Assistant  Surgeon. 
He  died  of  Yellow  Fever  at  Quemados,  Cuba, 

28  of  September,  1900. 
With  more  than  the  courage  and  devotion  of 
the  soldier,  he  risked  and  lost  his  life  to  show 
how  a  fearful  pestilence  is  communicated  and 
how  its  ravages  may  be  prevented. 

ARISTIDES   AGRAMONTE 

Dr.  Aristides  Agramonte  was  born  in  Puerto 
Principe,  Cuba,  on  June  3,  1868.  His  father  was 
the  well-known  insurgent,  General  Eduardo  Agra- 
monte, who  was  killed  in  battle  on  March  8,  1872. 
After  General  Agramonte's  death  his  family  emi- 
grated to  the  United  States,  where  the  son  received 


ARISTIDES    AGRAMONTE,    M.D. 

Member  of   the  U.  S.  A.   Yellow  Fever  Commission.      From  a 
photograph  taken  in  1902 


YELLOW   FEVER   COMMISSION  289 

his  education,  first  in  the  public  schools  and  then 
in  the  College  of  the  City  of  New  York.  He  stud- 
ied medicine  in  the  College  of  Physicians  and 
Surgeons  and  graduated  there  with  honour  on 
June  8,  1890,  receiving  the  third  Harston  prize 
for  clinical  reports. 

After  obtaining  his  degree  Dr.  Agramonte  held 
several  appointments  in  the  city  of  New  York,  two 
of  which  he  obtained  through  competitive  exam- 
ination. One  of  these  was  as  sanitary  inspector  in 
the  new  health  department,  the  other  as  assistant 
bacteriologist  to  the  health  department. 

In  May,  1898,  he  was  appointed  acting  assist- 
ant surgeon  in  the  United  States  Army,  and  in 
that  capacity  he  was  sent  to  Santiago  in  July  of 
the  same  year.  In  the  following  November  he  re- 
turned, and  after  presenting  a  report  of  the  inves- 
tigations made  by  him  at  Santiago,  he  was  sent  to 
Havana,  in  December,  to  make  studies  in  the  bac- 
teriology of  yellow  fever;  the  results  of  which 
were  published  in  the  Medical  News  for  Feb- 
ruary, 1900. 

In  May,  1901,  he  was  put  in  charge  of  the  army 
laboratory  of  the  Division  of  Cuba,  a  post  which 
he  retained  till  the  end  of  his  service  on  the  island. 
At  the  same  time  he  was  also  appointed  a  member 
of  the  Army  Commission  on  yellow  fever,  with 
Dr.  Reed,  Dr.  Carroll,  and  Dr.  Lazear. 


During  the  summer  of  1900  Dr.  Agramonte 
investigated  an  epidemic  of  yellow  fever  at  Santa 
Clara,  Cuba,  as  well  as  certain  cases  of  so-called 
pernicious  fever  at  Pinar  del  Rio.  The  latter 
proved  to  be  an  epidemic  of  yellow  fever  in  a  gar- 
rison of  800  troops,  and  as  the  cases  were  being 
treated  for  malaria  by  the  medical  officers  in 
charge,  Dr.  Agramonte  met  with  a  great  deal  of 
opposition  when  he  announced  a  contrary  opinion. 
For  his  determined  stand  in  carrying  out  his  views 
in  the  face  of  obstacles  and  for  the  general  excel- 
lence of  his  work  he  was  publicly  complimented 
by  his  commanding  officer. 

Dr.  Agramonte's  part  in  the  work  of  the  Yellow 
Fever  Commission,  as  I  have  already  said,  was 
that  of  the  pathological  work  and  the  autopsies; 
and  he  was  associated  with  the  commission  until 
the  return  of  Reed  and  Carroll  to  the  United 
States  in  February,  1901. 

In  August,  1900,  Dr.  Agramonte  received  the 
degree  of  M.  D.  from  the  Medical  Faculty  of 
Havana,  after  passing  incorporation  examinations, 
and  in  the  September  following  he  obtained,  by 
competitive  examination,  the  chair  of  bacteriology 
and  experimental  pathology  in  the  same  institu- 
tion, a  post  which  he  still  holds. 

The  "  Preliminary "  and  the  "  Additional 
Notes  "  in  which  the  Army  Commission  published 


YELLOW   FEVER   COMMISSION  291 

the  results  of  their  labours,  as  well  as  their  paper 
on  "  Experimental  Yellow  Fever,"  bear  Dr.  Agra- 
monte's  name,  with  those  of  the  other  members  of 
the  board.  Dr.  Agramonte  has,  moreover,  pub- 
lished several  valuable  articles  on  the  subject  in- 
dependently, a  list  of  which  I  give  below.  He  has 
also  issued  a  number  of  papers  on  subjects  other 
than  yellow  fever,  which  I  have  not  space  to 
record. 

LIST  OF  DR.  AGRAMONTE'S  INDEPENDENT  CONTRIBU- 
TIONS TO  THE  LITERATURE  OF  YELLOW  FEVER. 

"  El  Bac.  Icteroides  (Sanarelli)  y  el  Bac.  X  (Stern- 
berg)."  Ext.  of  an  Official  Report.  Cronica  Medico- 
Chirurgica,  Havana,  Oct.,  1899. 

"  La  Relacion  del  Bacilo  Icteroides  con  la  Fiebre 
Amarilla."  El  Progreso  Med.,  Havana,  March,  1900. 

"  El  Fracaso  del  Suero  Sanarelli."  Revista  de  Med. 
y  Chir.,  Havana,  March,  1900. 

"  Report  of  Bacteriological  Investigations  upon 
Yellow  Fever."  The  Med.  News,  February,  1900. 

"  Paludismo  y  Fiebre  Amarilla:  Seis  Casos  Clin- 
icos."  El  Progreso  Med.,  Havana,  Oct.,  1900. 

"  Anotaciones  acera  de  la  Etiologia  de  la  Fiebre 
Amarilla."  Revista  de  Med.  y  Chir.,  Aug.,  1901. 

"  La  Etiolgia  de  la  Fiebre  Amarilla."  Official  Re- 
port to  the  N.  Y.  Quarantine  Department,  Revista  de 
Med.  Tropical,  October  i,  1902. 

"  The  Supposed  Parasite  of  Yellow  Fever."  Re- 
vista Med.,  Cubana,  October,  1902. 


CONCLUSION 

I  would  the  great  world  grew  like  thee 
Who  grewest  not  alone  in  power 
And  knowledge,  but  by  year  and  hour 
In  reverence  and  in  charity. 


The  flame  is  quenched  that  I  foresaw, 
The  head  hath  missed  an  earthly  wreath; 
I  curse  not  nature,  no,  nor  death, 
For  nothing  is  that  errs  from  law. 

We  pass;  the  path  that  each  man  trod 
Is  dim,  or  will  be  dim  with  weeds ; 
What  fame  is  left  for  human  deeds 
In  endless  ages  rests  with  God. 

— TENNYSON*.  In  Memoriam. 

THIS  little  volume  is  my  tribute  to  the  memory 
of  a  great  and  good  man.  My  own  acquaintance 
with  Dr.  Reed  was,  I  regret  to  say,  but  a  brief  one, 
yet  it  made  upon  me  that  lasting  impression  which 
was  a  characteristic  of  his  personality,  and  which 
I  count  among  the  good  things  of  my  life.  The  fol- 
lowing letter  I  prize,  not  only  because  it  is  the  only 
one  I  ever  received  from  him,  but  because  it  con- 
tains a  reference  to  his  life-work. 

293 


294    WALTER   REED   AND   YELLOW   FEVER 


w»B   O(P*RTMCNT. 
6UROEON  GENERAL'S  OFFICE.- 


CONCLUSION  295 

I  have  tried  to  set  forth  in  these  pages  all  the 
benefits  which  Dr.  Reed's  talents  and  industry  have 
accomplished  for  the  world,  but  I  must  not  lay 
down  my  pen  without  tracing  some  of  the  uncon- 
scious lessons  which  such  a  life  holds  for  his  fellow- 
men. 

The  annals  of  Walter  Reed's  early  years  are  re- 
freshing in  their  simplicity.  They  record  a  natural, 
healthful  life,  with  habits  and  interests  in  no  wise 
different  from  those  of  thousands  of  American 
boys.  Nothing  in  its  circumstances  or  pursuits 
marked  him  out  as  different  from  his  fellows,  and 
his  character  was  distinguished  from  theirs,  not  by 
flashes  and  premonitions  of  genius,  but  by  a  re- 
markable uprightness,  earnestness  of  purpose,  and 
tenderness  of  heart.  Neither  his  youth  nor  his  ma- 
ture years  were  characterised  by  any  of  those  eccen- 
tricities which  it  is  often  the  fashion  to  consider 
inseparably  associated  with  genius;  indeed,  his 
whole  life  is  a  consistent  witness  to  the  falsity  of 
the  theory  which  exempts  a  man  of  unusual  abili- 
ties from  the  laws  governing  mankind  in  general, 
on  the  ground  that  exceptional  talent  is  in  itself 
abnormal.  The  popular  idea  that  the  gifted  few 
are  not  responsible  for  their  actions,  because  they 
are  themselves  a  deviation  from  the  normal,  and 
that  what  are  vices  in  their  fellow-men  are  venial 
errors  in  them,  finds  no  support  in  Walter  Reed's 


life.  Sanity,  next  to  earnest  Christian  principle, 
was  his  distinguishing  trait. 

Again,  let  those  who  complain  of  the  cramping 
influence  of  uncongenial  environment,  and  insist 
upon  the  necessity  of  opportunity  and  sympathetic 
surroundings  to  a  full  intellectual  development, 
review  the  record  of  the  forty  years  spent  by  Reed, 
first  in  his  quiet  Virginia  home,  and  then  on  the  far 
Western  frontier.  The  foundations  of  his  achieve- 
ments were  not  laid  amidst  a  stimulating  mental 
atmosphere,  nor  did  he  make  success  the  one  object 
in  life  to  which  all  other  aims  were  subordinated; 
on  the  contrary,  the  training  which  prepared  him, 
quite  unconsciously,  to  enter,  fully  equipped,  upon 
the  great  work  in  store  for  him,  was  a  constant, 
daily,  unselfish  devotion  to  the  needs  of  others, 
often  amid  most  uncongenial  surroundings. 

Yet  no  man  appreciated  the  value  of  opportunity 
more  than  Dr.  Reed.  He  put  forth  all  his  powers 
to  improve  every  possible  occasion  that  arose  in 
his  life,  and  here  again  we  find  a  lesson. 

It  is  unfortunately  the  fashion  at  present  to  fancy 
that  a  scientific  training  cannot  approach  perfec- 
tion unless  more  or  less  time  is  spent  in  a  foreign 
university.  A  man  is  not,  according  to  some  of  the 
best  authorities,  fully  equipped  as  a  scientist  if  all 
his  foundations  are  laid  and  his  methods  acquired 
in  the  United  States.  Americans  owe  a  debt  of  grat- 


CONCLUSION  297 

itude  to  Dr.  Reed  for  the  evidence  his  career 
affords  to  the  contrary.  His  medical  education  was 
received  in  Virginia  and  New  York,  and  his  train- 
ing in  pathology  and  bacteriology,  subjects  not  con- 
sidered in  a  medical  curriculum  in  his  undergrad- 
uate days,  was  acquired  entirely  at  the  Johns  Hop- 
kins University  and  Hospital.  He  himself  fully 
recognised  and  appreciated  his  obligations  to  the 
latter  institutions,  and  when,  after  his  return  from 
Cuba  in  1901,  he  delivered  the  annual  address  be- 
fore the  Medical  and  Chirurgical  Faculty  of  Bal- 
timore, he  paused  before  entering  upon  his  subject 
to  pay  a  graceful  tribute  to  the  advantages  afforded 
him  by  his  training  in  that  city,  saying  that  it  gave 
him  pleasure  to  feel  that  he  was  bringing  back  to 
Baltimore,  in  the  results  of  his  work  in  Cuba,  some 
return  for  all  that  he  had  received  there.  From 
first  to  last  Reed  was  the  product  of  his  native  coun- 
try, and  those  experiments  which  Dr.  Welch  de- 
clares "  will  always  remain  as  models  of  scientific 
research,"  were  the  fruit  of  knowledge  acquired 
and  methods  perfected  in  the  United  States. 

But  the  greatest  lesson  of  Dr.  Reed's  life  is  that 
the  secret  of  happiness  and  usefulness  lies  rather  in 
giving  what  we  can  to  life,  than  in  getting  what  we 
can  from  it.  It  was  his  consistent  adherence  to  this 
principle  which  raised  him  morally  so  far  above 
his  fellows.  His  constant  prayer  from  early  youth 


298    WALTER   REED   AND   YELLOW   FEVER 

was  that  he  might  be  permitted  to  alleviate  in  some 
degree  the  suffering  of  humanity,  and  all  his  efforts 
were  spent  in  striving  toward  this  goal,  without  a 
thought  of  self. 

Walter  Reed's  work  here  is  over;  his  humble, 
faithful  use  of  the  talents  committed  to  his  charge 
is  at  an  end,  and  he  has  entered  into  his  reward. 
When  we  are  tempted  to  mourn  over  his  untimely 
death,  and  to  regret  all  the  possibilities  which  a 
farther  use  of  his  abilities  might  have  developed, 
we  should  remember  the  words  of  Bishop  Law- 
rence of  Massachusetts  to  Mrs.  Reed,  after  her 
husband's  death:  "  Let  us  try  to  feel  that  the  Mas- 
ter took  him  because  he  had  other  work  for  him  to 
do."  Are  not  the  talents,  which  to  our  feeble  in- 
telligence seem  so  greatly  needed  by  our  present 
necessities,  still  employed  in  the  Master's  service 
in  ways  beyond  our  finite  understanding? 

"  O  strong  soul,  by  what  shore 
Tarriest  thou  now?    For  that  force, 
Surely,  has  not  been  left  vain! 
Somewhere,  surely,  afar, 
In  the  sounding  labour-house  vast 
Of  being,  is  practised  that  strength. 
Zealous,  beneficent,  firm!" 


BIBLIOGRAPHY* 

REED,  WALTER.    [1851-1902.] 

1892. — The  contagiousness  of  erysipelas.  Boston  M.  and  S.  ].,  v.  126 
(10),  March  10,  p.  237. 

1893. — Remarks  on  the  cholera  spirillum.  [An  address  before  Ram- 
sey County  Medical  Society,  March  28.]  Northwest.  Lancet,  St.  Paul, 
(297),  v.  13  (9),  May  i,  pp.  161-164. 

18940. — Association  of  Proteus  vulgaris  with  Diplococcus  lanceolatus 
in  a  case  of  croupous  pneumonia.  Johns  Hopkins  Hasp.  Bull.,  Balti- 
more, v.  5  (34),  March,  pp.  24-25. 

18942*. — The  germicidal  value  of  trikresol.  St.  Louis  M.  and  S.  J. 
(642),  v.  66  (6),  June,  pp.  329'337- 

1894*-. — Idem.  Proc.  Ass.  Mil.  Surg.  U.  S.  (Washington),  St.  Louis, 
v.  4,  pp.  199-208. 

1894^. — A  brief  contribution  to  the  identification  of  Streptococcus 
erysipelatos.  Boston  M.  and  S.  J.,  v.  131  (14),  October  4,  pp.  339-340. 

18950. — An  investigation  into  the  so-called  lymphoid  nodules  of  the 
liver  in  typhoid  fever.  Johns  Hopkins  Hosp.  Rep.,  Baltimore,  v.  5, 

PP-  379-396' 

1895^. — An  investigation  into  the  so-called  lymphoid  nodules  of  the 
liver  in  abdominal  typhus.  Am.  J.  M.  Sc.,  Philadelphia,  n.  s.,  v.  no, 

PP-  543-559- 

1895?. — What  credence  should  be  given  to  the  statements  of  those 
who  claim  to  furnish  vaccine  lymph  free  of  bacteria?  [Read  before 
the  District  of  Columbia  Md.  Soc.,  June  5.]  J.  Pract.  M.,  N.  Y.,  v.  5 
(12),  July,  pp.  532-534- 

18960. — [The  character,  prevalence,  and  probable  causation  of  the 
malarial  fevers  at  Washington  Barracks  and  Fort  Myer.]  Rep.  Surg. 
Gen.  Army,  Wash.,  pp.  65-77,  *  diagram,  i  table. 

1896*.— The  parasite  of  malaria.  J.  Pract.  M.,  N.  Y.,  v.  6  (9), 
Apr.,  pp.  382-383. 

*  This  bibliography  it  adopted  from  that  issued  by  toe   Medical  Society  of  the   District  of 
Columbia  <n  their  published  account  of  the  Memorial  Services  to  Dr.  Reed,  December  31,  1902. 

299 


300    WALTER   REED   AND  YELLOW  FEVER 

1897**. — Serum  diagnosis  in  typhoid  fever.  Rep.  Surg.  G«n.  Army, 
Wash.,  pp.  68-73. 

1897^. — On  the  appearance  of  certain  amoeboid  bodies  in  the  blood 
of  vaccinated  monkeys  (Rhoesus)  and  children,  and  in  the  blood  of 
variola.  An  experimental  study.  Tr.  Ass.  Am.  Physicians,  Phila.,  v. 
12,  pp.  291-302,  2  pis. 

i897f. — On  the  appearance  of  certain  amoeboid  bodies  in  the  blood 
of  vaccinated  monkeys  (Rhoesus)  and  children,  and  in  the  blood  from 
cases  of  variola.  An  experimental  study.  J.  Exper.  M.,  N.  Y.,  v.  a 
(5),  Sept.,  pp.  515-527.  Pi8-  38-40- 

1897^. — Typhoid  fever  in  the  District  of  Columbia;  diagnosis:  The 
value  of  Widal's  test,  the  dried  blood  method.  Nat.  M.  Rev.,  Wash.,  v 
7  (6),  Nov.,  pp.  144-i46. 

1897*. — [Experiments  with  Hollister's  formaldehyde  generator.] 
Rep.  Surg.  Gen.  Army,  Wash.,  pp.  103-104. 

1898. — Splenic  leukaemia.  {Trans.  Med.  Soc.  District  of  Columbia, 
Oct.  27.,  1897.]  Nat.  M.  Rev.,  Wash.  v.  7  (9),  Feb.,  pp.  265-266. 

1900. — Report  on  the  practical  use  of  electrozone  as  a  disinfectant  in 
the  city  of  Havana,  Cuba.  Rep.  Surg.  Gen.  Army,  Wash.,  pp.  178-186. 
[MS.,  dated  Apr.  20.] 

19010. — The  propagation  of  yellow  fever;  observations  based  on 
recent  researches.  [Address  before  xosd  Ann.  Meeting  Med.  and  Chir. 
Fac.,  State  of  Md.,  Bait.,  Apr.  24-27.]  Med.  Rec.,  N.  Y.  (1605),  v. 
60  (6),  Aug.  10,  pp.  201-209,  tables  i,  2. 

1901*. — Idem.  Rep.  Surg.  Gen.  Army,  Wash.,  pp.  187-202,  f  pi.,  6 
fever  charts. 

1902. — Recent  researches  concerning  the  etiology,  propagation  and 
prevention  of  yellow  fever,  by  the  United  States  Army  Commission. 
J.  Hyg.,  Cambridge,  Eng.,  y.  2.  (2),  Apr.  i,  pp.  101-119,  charts  1-3. 

REED,  WALTER,  and  CARROLL,  JAMES. 

18990. — Bacillus  icteroides  and  Bacillus  cholerae  suis.  A  prelimi- 
nary note.  Med.  News,  N.  Y.,  v.  74  (17),  Apr.  29,  pp.  513-514. 

1899^. — The  specific  cause  of  yellow  fever.  A  reply  to  Dr.  G. 
Sanarelli.  Med.  News,  N.  Y.,  v.  75  (n),  Sept.  9,  pp.  321-329. 

1900. — A  comparative  study  of  the  biological  characters  and  patho- 
genesis  of  Bacillus  x  (Sternberg),  Bacillus  icteroides  (Sanarelli), 
and  the  hog-cholera  bacillus  (Salmon  and  Smith).  [Received  for 


BIBLIOGRAPHY  301 

publication  Feb.  25.]  J.  Exper.  M.  [Bait],  v.  5  (3),  Dec.  15,  pp. 
215-270,  figs,  a-o,  pi.  19,  figs.  1-3. 

1901. — The  prevention  of  yellow  fever.  [Read  at  29th  Ann.  Meet- 
ing, Am.  Pub.  Health  Ass.,  Buffalo,  Sept.  16-21.]  Med.  Rec.,  N.  Y. 
(1616),  v.  60  (17),  Oct.  26,  pp.  641-649,  figs.  i-io. 

1902. — The  etiology  of  yellow  fever.  A  supplemental  note.  [Read 
at  3d  Ann.  Meeting,  Soc.  Am.  Bacteriologists,  Chicago,  Dec.  31,  1901, 
and  Jan.  i,  1902.]  Am.  Med.,  Phila.,  v.  3  (8),  Feb.  22,  pp.  301-305, 
charts  1-6. 

REED,  WALTER;  CARROLL,  JAMES,  and  AGRAMONTE,  ARISTIDES. 

190112. — The  etiology  of  yellow  fever.  An  additional  note.  [Read  at 
Pan-Am.  Med.  Cong.,  Havana,  Cuba,  Feb.  4-7.]  J.  Am.  Med.  Ass., 
Chicago,  v.  36  (7),  Feb.  16,  pp.  431-440,  charts  1-6. 

1901^. — Experimental  yellow  fever.  Am.  Med.,  Phila.,  v.  2  (i), 
July  6,  pp.  15-23,  charts  1-8,  tables  1-2. 

REED,  WALTER;  CARROLL,  JAMES;  AGRAMONTE,  ARISTIDES,  and  LAZBAR, 

JESSE  W. 

1900. — The  etiology  of  yellow  fever.  A  preliminary  note.  [Read 
at  Meeting  of  Am.  Pub.  Health  Ass.,  Indianapolis,  Ind.,  Oct.  22-26.] 
Phila.  M.  J.  (148),  v.  6  (17),  Oct.  27,  pp.  790-796,  tables  1-3,  charts  1-2. 

M 
~ 

REED,  WALTER,  and  STERNBERG,  GEORGE  M. 

1895. — Report  of  immunity  against  vaccination  conferred  upon  the 
monkey  by  the  use  of  the  serum  of  the  vaccinated  calf  and  monkey. 
Tr.  Ass.  Am.  Physicians,  Phila.,  v.  10,  pp.  57'69« 


INDEX 


INDEX 


Adams,  Dr.  S.  S.,  extract  from 
speech  at  Reed  memorial  ser- 
vices, 71 

Agramonte,  Dr.  Aristides:  Birth, 
288;  education,  289;  independ- 
ent publications  on  yellow  fever, 
291;  preliminary  work  in  yellow 
fever,  289;  work  at  Pinar  del  Rio, 
290;  work  on  yellow  fever  com- 
mission, 290 

Agramonte,  General  Eduardo,  271 

Air-pump,  accident  with,  in  Dr. 
Carroll's  experiments,  178 

Alabama,  Reed's  life  in,  59 

Ames,  Dr.  Roger  P.,  137 

Anopheles,  species  of,  112,  129 

Antitoxin,  extract  from  Reed's 
speech  in  favour  of,  71 

Apache,  camp,  30;  journey  to, 
31-42;  letter  from,  42-49 

Arizona,  Reed's  life  in,  30 

Armstrong,  Rev.  George,  on 
yellow  fever  in  Norfolk,  Va., 
228 

Army  Medical  Corps,  injustice 
done  to,  in  Spanish-American 
war,  72 

Army,  United  States,  Reed's 
reasons  for  entering,  11-15 

Bacillus,  of  hog-cholera,  121; 
icteroides,  120,  121,  122,  123, 


251;  Klebs-Loeffler,  70;  X,  120, 
122 

Bancroft,  Dr.,  100 
Banister,  Major  W.  B.,  257 
Baxter,  Surgeon-General,  61 
Bell,  Dr.  Alexander  Graham,  259 
Bell,  Dr.  Charles  J.,  260,  261 
Bellevue    Hospital    Medical    Col- 
lege, 8 

Blincoe,  Mrs.  J.  R.,  4 
Borden,  Major  W.  C.,  253,  254, 

255,  256 

Bush-Hill  Hospital,  214,  216 
Boyce,    Mr.    Rupert,    on    yellow 
fever  in  New  Orleans  in   1905, 

202 

Carey,  Mathew,  2ii ;  extracts  from 
published  writings,  212-214,  215, 
229 

Carroll,  Dr.  James:  Birth,  262; 
education,  263;  experiments  at 
Quemados,  166-180;  experi- 
ments at  Las  Animas  Hospital, 
266-273;  extracts  from  publica- 
tions on  yellow  fever,  133,  273, 
274,  275,  276,  277,  278;  heart 
affection  from  yellow  fever,  265; 
incident  during  convalescence, 
264;  independent  publications  on 
yellow  fever,  281;  inoculation 
with  infected  mosquito,  132,  264; 


306 


INDEX 


letters  to  Dr.   Reed,   167,   169, 

178,  268;  tribute  to  Dr.  Lazear, 

285;   yellow   fever   commission, 

appointment  to,   263;   value  of 

services,  266 

Carter,  Dr.  Henry  R.,  126,  161 
Chaille,  Dr.  Stanford,  204 
Character,     deterioration     of,     in 

epidemics,  227 
Clarkson,  Matthew,  203 
Clements,  Dr.  J.  M.,  92 
Cooke,  Dr.  Roger  P.,  137,  149 
Contagion  theory  of  yellow  fever, 

discussion  of,  85-95 
Contagiousness       of       erysipelas, 

Reed's  paper  on,  69 
Contract,  form  of,  between  U.  S. 

Government  and  volunteers  for 

experiment,  172 
Culex  fasciatus,  128 

Dakota,    Reed's    appointment   to, 

67 

Davidge,  Dr.,  86 
Davis,  Major  W.  B.,  257 
De  Witt,  General  Calvin,  256,  260 
Deveze,  Dr.  Jean,  87 
Donnally,  Dr.  H.  H.,  on  Reed  as  a 

teacher,  248 

Elam,  Mrs.  D.  T.,  n 
Eliot,  President,  250,  258,  288 
Epidemics   of  yellow   fever:    Bal- 
timore, in   1819,  90;   Boston,  in 
1691,  83;   Central    America,  in 
1596,   83;   Charleston,  in   1699, 
83;   Grenada,   Miss.,   in    1878, 
232-234;  Havana,  in  1901,  182- 
187;  in  1900,  235-238;  Island  of 
St.  Lucia,  in  1664,  83;  Memphis, 


in  1878,  84,  91,  223-232;  Nan- 
tucket,  in  1763,  210;  New 
Orleans,  in  1853,  84,  91;  in  1905, 
196-203;  Norfolk,  Va.,  1855, 
220;  Philadelphia,  1793,  210, 
211-225 

Experiments  by  yellow  fever  com- 
mission: Fomites,  145-150;  in- 
fection of  houses,  150-152;  in- 
oculation with  blood,  155,  173; 
with  mosquito,  131-143;  with 
serum,  174-177;  length  of  time 
between  infection  of  mosquito 
and  power  to  transmit  disease, 
155,  157,  177;  length  of  time  that 
infection  can  be  conveyed,  159; 
nature  of  specific  germ,  164,  174 

Ffirth,  Stubbing,  262,  278 
Finlay,    Dr.    Carlos    J.,    113-117, 

128,  129,  154 
Fomites,  introduction  of  term,  93, 

119;   Reed's   experiments   with, 

I 45-1 5° 
Ford,  Dr.,  92 
Freire,  Dr.  Domingo,  117 

Gilman,  Dr.  D.  C.,  260 
Girard,  Stephen,  214,  215 
Grenada,  Miss.,  yellow  fever  at,  in 

1878,  232-234 
Guiteras,   Dr.   G.   M.,   187,   188; 

extracts  from  paper  on  epidemic 

at  Laredo,  Texas,    181-185 
Guiteras,    Dr.    John,   inoculation, 

experiments  by,  166,  267,  268 

Harrell,  Mrs.  J.  N.,  Reed's  letters 
to,  25-29,  32-34,  42-49 


INDEX 


307 


Harvard      University,      honorary 

degree  from,  250 
Havana,    appreciation    of   Reed's 

work  in,  163;  extermination  of 

yellow  fever  in,  174-179 
Helm,  Peter,  206 
Hodge,  Dr.,  211 
Horlbeck,  Dr.,  239    - 
Howard  Association,  231 
Howard,  John,  231 
Howard,  Dr.  L.  O.,  203,  204 
Hutchison,  Dr.  J.  C.,  10 
Hygiene,  extract  from  Journal  of, 

182-186 

Indians,   Reed's   popularity   with, 

51 

Insects  in  transmission  of  disease, 
earliest  mention  of,  96;  develop- 
ment of  knowledge  concerning, 
102-112;  King  on,  101;  Nott  on, 
112;  Nuttall  on,  76 

Jernigan,  volunteer  for  experi- 
mental inoculation,  155;  Johns 
Hopkins  Hospital,  Reed's  work 
at,  60,  62-67;  Johns  Hopkins 
University,  Reed's  work  at,  57 

Johns  Hopkins  Hospital,  Reed's 
work  at,  60 

Johns  Hopkins  University,  Reed's 
work  at,  80 

Kean,  Major  J.  R.,  71,  243,  254, 
256,  257,  260 

Keating,  J.  M.,  extracts  from 
history  of  yellow  fever  epidemic 
of  1878  in  Memphis,  83,93,223, 
224-226,  226-227,  230,  231,  239, 
250 


Keen,  Dr.  W.  W.,  260 

Kelly,  Dr.  H.  A.,  letter  to,  from 
Reed,  294 

King,  Dr.  A.  F..A.,  260;  on  insects 
and  disease,  100;  on  Reed  as  a 
teacher,  246 

King's  County  Hospital,  9 

Kinyoun,  Dr.,  on  prevention  and 
control  of  diphtheria,  70 

Kircher,  Athanasius,  97 

Kissinger,  John,  volunteer  for  ex- 
perimental inoculation,  139, 140- 
142 

Knud,  Bishop,  97 

Kyle,  Mrs.,  n 

Labadie,  Dr.,  92 

La  Grade,  Major  Louis  A.,  257 

Laredo,   Texas,   extermination   of 

yellow  fever  at,  187-196 
Lawrence,  Bishop,  298 
Lawrence,  Miss  Emilie:  Parentage, 
II ;  engagement  to  Dr.  Reed,  19; 
Reed's  letters  to,  12-14,  15,  16, 
17,  18,  19,  20,  21 
Lawrence,  John  Vaughan,  1 1 
Lazear  camp,  establishment  of,  136 
Lazear,   Dr.    Jesse  W.:    appoint- 
ment to  yellow  fever  commission, 
123,  283;  association  with  Johns 
Hopkins    Hospital,    282;    birth, 
281;  education,  282;  inoculation 
with    infected     mosquito,     134, 
283;  interment,   284;  tablet  to, 
in  Johns  Hopkins  Hospital,  288; 
tributes  to,  by  Carroll,  285;  by 
Reed,    287;    by    Thayer,    285; 
work  in  bacteriology,  282;  yellow 
fever,   illness   and   death   from, 
134,  284 


308 


INDEX 


Lee,  Dr.  Benjamin,  240 

Le  Maigre,  Mrs.,  21 1 

Lessons  of  Reed's  life,  295-298 

Lewis,  Dr.  J.  R.,  100 

Loeffler  and  Frosch,  experiments 

by,  165 
Lowell,  Fort,  24,  31 

MacCallum,  Dr.  W.  G.,  105 

MacLean,  Dr.  Charles,  86 

Malaria,  transmission  of,  by  mos- 
quito, suggested  by  King,  100; 
parasite  discovered  by  Laveran, 
103;  theory  of  insect  transmis- 
sion developed  by  Manson,  104; 
demonstrated  experimentally  by 
Ross,  1 06,  112 

Manson,  Sir  Patrick,  on  filiaria 
sanguinis  hominis,  98-100;  on 
transmission  of  malaria  by  the 
mosquito,  104 

Martial  law,  advisability  of,  during 
epidemics  of  yellow  fever,  195 

Martinez,  volunteer  for  experi- 
mental inoculation,  157 

Matas,  Dr.  Rudolph,  188;  letter 
to,  from  Dr.  J.  H.  White,  196- 

201 

Maupin,  Dr.,  7 

McCaw,  Dr.  W.  D.,  49,  257,  260; 
extract  from  memoir  of  Reed, 

6? 

McHenry,  Fort,  57 
Medical  and  Chirurgical  Faculty 

of  Maryland,  Reed's  address  to, 

245.  ?97 
Memorial      Association,      Walter 

Reed,  242,  259 

Memphis,  epidemic  of  yellow  fever 
at,  in  1878,  84,  91,  223-232 


"Mervyn,  Arthur,"  romance  by  C. 

B.  Brown,  223 
Methods  of  exterminating  yellow 

fever,    182-187,    189-196,    196- 

203 
Michigan,   honorary   degree   from 

University  of,  252 
Monterey,   Reed's   summer   home 

at,  249 
Monument  to  Reed  at  Arlington, 

257 

Moran,  John  J.,  volunteer  for  ex- 
perimental inoculation,  139,  151 
Mortality  in  yellow  fever,  83,  84, 

204,  210,  221,  233,  238 

Nantucket,     epidemic    of    yellow 

fever  at,  in  1763,  210 
National  prosperity,  injury  to,  by 

yellow  fever,  239 
Nebraska,  Reed's  life  in,  57 
New  Orleans,  epidemic  of  yellow 

fever  at,  in   1853,  91;  in   1905, 

196-205 
Nott,  Dr.  J.  C.,  on  transmission  of 

yellow  fever  by  mosquitoes,  112 
Nuttall,  Dr.  G.  F.  H.,  on  insects  as 

carriers  of  disease,  96;  on  Reed, 

259 
Omaha,  Fort,  57 

Pan-American  Congress,  report  of 

experiments  in  yellow  fever  to, 

161 
Pare,     Ambroise,     extract     from 

description  of  battle-field  of  St. 

Quentin,  97 
Philadelphia,   epidemic   of  yellow 


INDEX 


309 


fever  at,  in  1793,  83,  84-90, 
211-223 

Pilcher,  Dr.  J.  W.,  tribute  by,  to 
Dr.  Carroll,  279 

Pinar  del  Rio,  epidemic  of  yellow 
fever  at,  in  1900,  124-126 

Potter,  Dr.  Nathaniel,  on  non- 
contagiousness  of  yellow  fever, 
85 

Quarantine  regulations  against  yel- 
low fever,  205-209;  cruelties  of, 
218,  219;  expense  of,  241 

Reed,  Christopher,  4,  5,  7,  8,  9 
Reed,  Emilie  Lawrence,  57 
Reed,  James,  4 
Reed,    Reverend    Lemuel    Sutton, 

3,  " 

Reed,  Walter:  Birth,  i;  college  life, 
6-8;  death,  256;  early  education, 
4-6;  engagement  to  Miss  Law- 
rence, 19;  Harvard  degree,  250; 
health,  failure  of,  254;  interment, 
256;  Johns  Hopkins  Hospital, 
work  at,  60;  Johns  Hopkins 
University,  work  at,  57;  last  ill- 
ness, 253-256;  lessons  of  life, 
295-298;  life  in  Alabama,  59; 
life  in  Arizona,  24-56;  life  in 
Nebraska,  57-59;  life  in  New 
York  and  Brooklyn,  8-18;  life 
in  Washington,  before  going  to 
Cuba,  67;  after  return  from  Cuba, 
252;  love  of  sport,  51;  marriage, 
23;  Michigan,  degree  from  Uni- 
versity of,  252;  Monterey,  sum- 
mer home  at,  249;  monument  to, 
?'.  Arlington,  257;  parents,  3; 


services  to  world,  242-244; 
teacher,  success  as,  246-248; 
typhoid  fever  commission,  work 
upon,  74-76;  universal  regret  at 
death,  258;  yellow  fever  com- 
mission, appointment  to,  123, 
work  upon  (see  yellow  fever) 

Reed,  Walter,  letters  from,  to 
Carroll,  163,  171,  269,  270,  272; 
to  Mrs.  J.  N.  Harrell,  25,  32,  42; 
to  Dr.  H.  A.  Kelly,  294;  to  Miss 
Lawrence,  15,  16,  17,  18,  19,  20, 
21 ;  to  Mrs.  Reed,  53,  140,  148, 
152,  154,  163;  to  Dr.  Theobald 
Smith,  243 

Reed,  Walter  Lawrence,  42,  256 

Reed,  Thomas,  4 

Root,  Mr.  Elihu,  75 

Ross,  Major  Ronald,  work  on 
mosquito  theory  of  malaria, 
105-1 I I 

Rush,  Dr.  Benjamin,  84:  Support 
of  contagion  theory  of  yellow 
fever,  87;  recantation  of  opinion, 
88;  extract  from  account  of 
Philadelphia  epidemic  of  1793, 
217-221;  opinion  as  to  origin  of 
yellow  fever,  222 

Sanarelli,  Giuseppe,  controversy 
with  Reed  and  Carroll,  120-122, 
263 

San  Domingo,  yellow  fever  im- 
ported from,  221 

Sansom,  William,  216 

Schuler,  Hans,  258 

Shakespeare,  Dr.  E.  O.,  74 

Smith,  Dr.  Theobald,  Il6;  letter 
from,  to  Reed,  251 

Sonsino,  Dr.,  100 


310 


INDEX 


Spanish-American  War,  Reed's 
wish  to  hold  office  in,  72;  in- 
justice done  to  Army  Medical 
Corps  during,  72-74 

Stegomyia  fasciata,  129,  130,  180, 
266 

Sternberg,  General  G.  M.,  117, 
1 1 8,  164,  260,  263 

Stille,  Professor  P.,  92 

Stone,  Captain  J.  Hamilton,  on 
Reed  as  a  teacher,  247 

Stone,  Dr.  Warren,  92 

Synonyms  for  yellow  fever,  82 

Table,  comparative,  of  deaths  from 
yellow  fever,  204 

Tabor,  Dr.  George  R.,  188 

Telegram  from  Reed  to  Carroll, 
271 

Thayer,  Dr.  W.  S.,  tribute  by,  to 
Dr.  Lazear,  285 

Theobald,  F.  V.,  129 

Theories  of  yellow  fever,  contagion, 
85-91;  direct  importation,  84; 
earliest,  92;  fomites,  93;  local 
origin,  85;  transmission  of,  by 
mosquitoes,  112,  113-117,  127 

Tomkins,  Jacob,  216 

Typhoid  fever  commission,  mem- 
bers of,  74;  Reed's  services  on, 
75-76;  extracts  from  published 
report  of,  76-79 

Valle,  Dr.  Carmona  Y.,  118 
Vaughan,  Dr.  V.  C,  74,  75 
Volunteers  for  experimental  inocu- 
lation, 139,  155,  157,  159,  170 


Warner,  Reverend  Beverley,  189 

Warner,  Mrs.  Lena,  description 
by,  of  epidemic  at  Grenada, 
Miss.,  233-234;  of  epidemic  at 
Havana,  235-237 

Welch,  Dr.  W.  H.,  165,  257;  on 
Reed's  work  at  Johns  Hopkins 
Hospital,  63-67 

Wilson,  James,  216 

White,  Dr.  J.  H.,  letter  from,  to 
Dr.  Matas  describing  extermina- 
tion of  yellow  fever  at  New 
Orleans  in  1905,  196,  205 

Wood,  Major-General  Leonard, 
1 80,  240 

Wyman,  General  Walter,  on 
quarantine  regulations,  209,  241 

Yellow  fever:  Clinical  description 
of,  80;  mortality  from,  83,  84, 
204,  210,  221,  233,  238;  methods 
of  extermination,  182-187,  189- 
196,  196-203;  nature  of  specific 
germ,  164,  174;  quarantine  regu- 
lations against,  205-209,  218, 
219,  241;  synonyms  for,  82; 
treatment  of,  81,  273,  274,  275, 
277 

Yellow  fever,  theories  of:  Con- 
tagion, 85;  direct  importation, 
84;  earliest,  92;  local  origin,  85; 
fomites,  93;  transmission  by 
mosquitoes,  112,  113-117,  127 

Yellow  Fever  Commission:  Ap- 
pointment of,  122;  experiments 
by  (see  experiments);  members 
of,  123 


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